MEDICARE: INDIA NEWSOME

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		TX
2	106S00000X	Behavior Technician	RBT-15-01163	TX

General Provider Information

NPI Number	:	1770033243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDIA NEWSOME

Provider Business Mailing Address
First Line	:	2600 WESTHOLLOW DR
Second Line	:	APT 1221
City	:	HOUSTON
State	:	TX
Zip	:	77082-1912
Country	:	US
Telephone Number	:	832-235-3563
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 WESTHOLLOW DR
Second Line	:	APT 1221
City	:	HOUSTON
State	:	TX
Zip	:	77082-1912
Country	:	US
Telephone Number	:	832-235-3563
Fax Number	:

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

Provider Enumeration Date	:	10/09/2016
Last Update Date	:	10/09/2016

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Directions to “ INDIA NEWSOME ” Practice Location

Language	Start Address	Practice Location

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