Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Timothy Nathan Lewis

Individual provider Professional Counselor · NPI 1629673314

Timothy Nathan Lewis is a Mental Health Counselor in Rockford, Illinois. Qualified in 2020, 6 years ago. Practices with Renita Shores-Gaston, a 6-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
6
Licensed in
IL
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

695 N Perryville Rd Ste 4
Rockford, IL 61107-6225
Phone: (779) 368-0060
Fax: (815) 977-4892
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 180015275 (IL)
Professional Counselor Taxonomy 101YP2500X · Licence 178016413 (IL)

Record details

NPI number1629673314
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 1, 2020
Last updated in NPPESMay 23, 2023
Certification dateMay 23, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Renita Shores-Gaston — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Rockford