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NPI Code Detail

MEDICARE: LISA YAVETTE LOWERY CACDI 02137-L

MEDICARE: LISA YAVETTE LOWERY CACDI 02137-L
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
1101YA0400XAddiction (Substance Use Disorder) Counselor02137-LNV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881177012
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA YAVETTE LOWERY CACDI 02137-L
Provider Business Mailing Address
First Line : 3583 SPRING SHOWER DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-3733
Country : US
Telephone Number : 206-245-0775
Fax Number :
Provider Business Practice Location Address
First Line : 3920 W CHARLESTON BLVD STE O
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1633
Country : US
Telephone Number : 702-478-5541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2018
Last Update Date : 09/13/2018

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