Provider Demographics
NPI:1225481559
Name:FUNCHESS, LEZLIE
Entity Type:Individual
Prefix:MR
First Name:LEZLIE
Middle Name:
Last Name:FUNCHESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270174
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89127-4174
Mailing Address - Country:US
Mailing Address - Phone:702-778-8922
Mailing Address - Fax:
Practice Address - Street 1:101 S RAINBOW BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5370
Practice Address - Country:US
Practice Address - Phone:702-778-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst