Active NPI
Matthew Lewis
- Exercise & Sports Psychologist
- San Tan Valley, AZ
National Provider Identifier
1720852791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exercise & Sports Psychologist
- Practice address
- 3711 E Meadow Land Dr
San Tan Valley, AZ 85140-5338 - Phone
- (805) 206-9868
- NPI assigned
- Nov 10, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | |||
| Exercise & Sports Psychologist | 103TE1100X | Primary |
Addresses
Primary practice location
3711 E Meadow Land Dr
San Tan Valley, AZ 85140-5338
Mailing address
3711 E Meadow Land Dr
San Tan Valley, AZ 85140-5338
Phone (805) 206-9868
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699574400000",
"number": "1720852791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3711 E MEADOW LAND DR",
"city": "SAN TAN VALLEY",
"state": "AZ",
"postal_code": "851405338",
"telephone_number": "805-206-9868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3711 E MEADOW LAND DR",
"city": "SAN TAN VALLEY",
"state": "AZ",
"postal_code": "851405338",
"telephone_number": "805-206-9868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-10",
"last_updated": "2023-11-10",
"certification_date": "2023-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TE1100X",
"taxonomy_group": "",
"desc": "Psychologist, Exercise & Sports",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Tan Valley, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.