Basic Information
| Provider Information | |||||||||
| NPI: | 1487605606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS STEVENS | ||||||||
| FirstName: | TASHA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 344 | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478420344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7658281003 | ||||||||
| FaxNumber: | 7658281030 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 S MAIN ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CLINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478422493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7658281003 | ||||||||
| FaxNumber: | 7658281030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34004589 | IN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 363LP0808X | 71010158A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.