MEDICARE: MEGAN LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-21-173496	TN
2	103K00000X	Behavior Analyst	1606	TN

General Provider Information

NPI Number	:	1245979012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN LEWIS

Provider Business Mailing Address
First Line	:	219 SUNNYSIDE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3301
Country	:	US
Telephone Number	:	731-336-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	79 SAND PEBBLE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-7591
Country	:	US
Telephone Number	:	855-444-5664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	09/10/2024

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