MEDICARE: HANNELORE TOREY LEWIS M.ED., BCBA

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	103K00000X	Behavior Analyst	1-13-14690	TX

General Provider Information

NPI Number	:	1477965309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNELORE TOREY LEWIS M.ED., BCBA

Provider Business Mailing Address
First Line	:	PO BOX 24040
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76702-4040
Country	:	US
Telephone Number	:	254-732-2262
Fax Number	:	254-732-2263

Provider Business Practice Location Address
First Line	:	635 N ROBINSON DR
Second Line	:	SUITE K
City	:	ROBINSON
State	:	TX
Zip	:	76706-5330
Country	:	US
Telephone Number	:	254-732-2262
Fax Number	:	254-732-2263

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

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	05/27/2014

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