Healthcare Provider Details

I. General information

NPI: 1760057285
Provider Name (Legal Business Name): ANDREW LEWIS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 ABLE CT
MOBILE AL
36693-3100
US

IV. Provider business mailing address

11401 GRAND TERRACE CIR S
GRAND BAY AL
36541-7321
US

V. Phone/Fax

Practice location:
  • Phone: 251-644-5938
  • Fax:
Mailing address:
  • Phone: 251-422-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number2024-078
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: