MEDICARE: THEAVIA LEIGH LEWINSON M.S.

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	106S00000X	Behavior Technician	RBT-18-48892	TX
2	103K00000X	Behavior Analyst	1-22-60893	TX

General Provider Information

NPI Number	:	1750855748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEAVIA LEIGH LEWINSON M.S.

Provider Business Mailing Address
First Line	:	12655 CROSSROADS PARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3375
Country	:	US
Telephone Number	:	786-395-4508
Fax Number	:

Provider Business Practice Location Address
First Line	:	9610 HUFFMEISTER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2895
Country	:	US
Telephone Number	:	612-702-6068
Fax Number	:

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	09/24/2024

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