Individual
MR. KELLY A LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2180 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4513
(805) 781-4394
Mailing address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
(805) 781-4868
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT36628
CA
Other
Enumeration date
09/27/2012
Last updated
05/29/2025
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