Provider Demographics
NPI:1891678405
Name:LEWIS, TRAE MICHAEL
Entity type:Individual
Prefix:MR
First Name:TRAE
Middle Name:MICHAEL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 N DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-1765
Mailing Address - Country:US
Mailing Address - Phone:559-901-6817
Mailing Address - Fax:
Practice Address - Street 1:426 N BLACKSTONE ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4449
Practice Address - Country:US
Practice Address - Phone:559-688-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool