MEDICARE: LAVELL RENFRO

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

General Provider Information

NPI Number	:	1033469085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVELL RENFRO

Provider Business Mailing Address
First Line	:	2200 S FORT APACHE RD
Second Line	:	UNIT #2150
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5705
Country	:	US
Telephone Number	:	252-229-9887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 S FORT APACHE RD
Second Line	:	UNIT #2150
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5705
Country	:	US
Telephone Number	:	252-229-9887
Fax Number	:

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

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	09/18/2012

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Directions to “ LAVELL RENFRO ” Practice Location

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