Healthcare Provider Details

I. General information

NPI: 1992339600
Provider Name (Legal Business Name): MYESHA LEWIS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SAINT JOSEPH LN
MANCHESTER MO
63021-5316
US

IV. Provider business mailing address

2055 CRAIGSHIRE DR STE 410
SAINT LOUIS MO
63146-4012
US

V. Phone/Fax

Practice location:
  • Phone: 636-534-5099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-101211
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: