Healthcare Provider Details

I. General information

NPI: 1063836369
Provider Name (Legal Business Name): MARCIA LEWIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 ASPEN PEAK LOOP #225
HENDERSON NV
89011-1803
US

IV. Provider business mailing address

833 ASPEN PEAK LOOP #225
HENDERSON NV
89011
US

V. Phone/Fax

Practice location:
  • Phone: 916-284-0404
  • Fax:
Mailing address:
  • Phone: 916-284-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARCIA KAY LEWIS
Title or Position: BASIC SKILLS TRAINER
Credential:
Phone: 916-284-0404