MEDICARE: T'OSHA LEE

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	:	1558727149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	T'OSHA LEE

Provider Business Mailing Address
First Line	:	3757 DUSKY FLYCATCHER ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 ATLANTA ST STE 100
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-2192
Country	:	US
Telephone Number	:	470-488-0515
Fax Number	:

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

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	06/11/2019

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Directions to “ T'OSHA LEE ” Practice Location

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