MEDICARE: LOURIE STAINE-WILLIAMS

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	:	1275346389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURIE STAINE-WILLIAMS

Provider Business Mailing Address
First Line	:	4130 N MLK BLVD STE A
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0299
Country	:	US
Telephone Number	:	702-485-1313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 TOSCANINI WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0651
Country	:	US
Telephone Number	:	702-485-1313
Fax Number	:

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

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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Directions to “ LOURIE STAINE-WILLIAMS ” Practice Location

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