Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 103K00000X | Behavior Analyst | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043564032 |
---|---|
Provider Name | Mr. David Lewis |
First Address | Las Vegas, NV 89113-4085 |
Second Address | Las Vegas, NV 89113-4085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2012 |
Last Update Date | 28/02/2020 |