MEDICARE: MARTHA E LEWIS EDUCATION

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	:	1821342155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA E LEWIS EDUCATION

Provider Business Mailing Address
First Line	:	1840 BARREL OAK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5087
Country	:	US
Telephone Number	:	702-572-3560
Fax Number	:	702-647-0861

Provider Business Practice Location Address
First Line	:	1840 BARREL OAK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5087
Country	:	US
Telephone Number	:	702-572-3560
Fax Number	:	702-647-0861

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

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	11/08/2012

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Directions to “ MARTHA E LEWIS EDUCATION” Practice Location

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