MEDICARE: RAMELLA LEE BCBA

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	1-16-23813	CA
2	103K00000X	Behavior Analyst	LBA0137	NV

General Provider Information

NPI Number	:	1184175929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMELLA LEE BCBA

Provider Business Mailing Address
First Line	:	3157 N RAINBOW BLVD STE K7-247
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	702-900-7698
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1839
Country	:	US
Telephone Number	:	702-900-7698
Fax Number	:

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

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	01/07/2026

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