MEDICARE: AXIS, APPLIED INTEGRATED SERVICES, LLC

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	RBT1623104	CA
2	106S00000X	Behavior Technician	RBT1623765	CA
3	103K00000X	Behavior Analyst	1118979	CA

General Provider Information

NPI Number	:	1811432628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIS, APPLIED INTEGRATED SERVICES, LLC

Provider Business Mailing Address
First Line	:	922 57TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3328
Country	:	US
Telephone Number	:	916-228-4169
Fax Number	:

Provider Business Practice Location Address
First Line	:	922 57TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3328
Country	:	US
Telephone Number	:	916-228-4169
Fax Number	:

Authorized Official
Title or Position	:	OWNER/BEHAVIORIST
Name	:	WILLIAM MORRIS
Credential	:	M.A.
Telephone Number	:	916-239-9589

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/16/2017

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