MEDICARE: DENISE DARLENE 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1316304496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE DARLENE LEWIS

Provider Business Mailing Address
First Line	:	3335 HAUCK ST APT 2043
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8024
Country	:	US
Telephone Number	:	702-300-1473
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 HAUCK ST APT 2043
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8024
Country	:	US
Telephone Number	:	702-300-1473
Fax Number	:

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

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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Directions to “ DENISE DARLENE LEWIS ” Practice Location

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