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NPI Code Detail

MEDICARE: JAMES LESAR

MEDICARE: JAMES LESAR
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1952837072
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES LESAR
Provider Business Mailing Address
First Line : 3809 LAKE EASTBROOK BLVD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-5931
Country : US
Telephone Number : 616-604-8492
Fax Number :
Provider Business Practice Location Address
First Line : 3809 LAKE EASTBROOK BLVD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-5931
Country : US
Telephone Number : 616-604-8492
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2017
Last Update Date : 02/25/2025

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Directions to “ JAMES LESAR ” Practice Location

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