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NPI Code Detail

MEDICARE: MR. DONNIE BQ LEWIS

MEDICARE: MR. DONNIE BQ LEWIS
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
1103K00000XBehavior Analyst
2101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083979553
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONNIE BQ LEWIS
Provider Business Mailing Address
First Line : 8821 WINDY HOLLOW DR
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-7460
Country : US
Telephone Number : 405-361-4730
Fax Number :
Provider Business Practice Location Address
First Line : 10948 N MAY AVE STE B
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-6224
Country : US
Telephone Number : 405-751-8889
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2012
Last Update Date : 12/22/2012

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