MEDICARE: ALTAMIT LEWIS LCPC

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	101YP2500X	Professional Counselor	LC3744	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CP0086	OTHER	NV	NEVADA BOARD OF EXAMINERS
2	LC3744	OTHER	MD	LCPC
3	PRC14337	OTHER	DC	DC DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1306010392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALTAMIT LEWIS LCPC

Provider Business Mailing Address
First Line	:	6532 GUMWOOD RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4415
Country	:	US
Telephone Number	:	702-499-6401
Fax Number	:

Provider Business Practice Location Address
First Line	:	6532 GUMWOOD RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4415
Country	:	US
Telephone Number	:	702-499-6401
Fax Number	:

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

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	01/13/2014

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