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NPI Code Detail

MEDICARE: AUDREY LEWIS BCBA

MEDICARE: AUDREY LEWIS 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
1103K00000XBehavior Analyst5056TX
2103K00000XBehavior Analyst1-20-42091AL

General Provider Information

NPI Number : 1194343467
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY LEWIS BCBA
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16712 HUFFMEISTER RD BLDG 500
Second Line :
City : CYPRESS
State : TX
Zip : 77429-8050
Country : US
Telephone Number : 281-746-6037
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2020
Last Update Date : 05/06/2026

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