Provider Demographics
NPI:1063836369
Name:MARCIA LEWIS
Entity Type:Organization
Organization Name:MARCIA LEWIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BASIC SKILLS TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-284-0404
Mailing Address - Street 1:833 ASPEN PEAK LOOP
Mailing Address - Street 2:#225
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011
Mailing Address - Country:US
Mailing Address - Phone:916-284-0404
Mailing Address - Fax:
Practice Address - Street 1:833 ASPEN PEAK LOOP
Practice Address - Street 2:#225
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-1803
Practice Address - Country:US
Practice Address - Phone:916-284-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty