Provider Demographics
NPI:1871924175
Name:LEWIS, TANIA M (LCSW, LCDC)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 REVEILLE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4089
Mailing Address - Country:US
Mailing Address - Phone:817-528-6710
Mailing Address - Fax:817-423-7504
Practice Address - Street 1:904 REVEILLE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4089
Practice Address - Country:US
Practice Address - Phone:817-528-6710
Practice Address - Fax:817-423-7504
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582491041C0700X
TX12496101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)