Individual
KRYSTAL MEREDITH LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUPERVISED LADC
Contact information
Practice address
605 W GORE BLVD STE 1, LAWTON, OK 73501-3732
(580) 250-1406
Mailing address
6 SW 69TH ST APT D, LAWTON, OK 73505-6724
(580) 264-3090
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100734740A
—
OK
Enumeration date
10/19/2009
Last updated
10/19/2009
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