Provider Demographics
NPI:1477965309
Name:LEWIS, HANNELORE TOREY (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:HANNELORE TOREY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MED, BCBA
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 24040
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-4040
Mailing Address - Country:US
Mailing Address - Phone:254-732-2262
Mailing Address - Fax:254-732-2263
Practice Address - Street 1:635 N ROBINSON DR
Practice Address - Street 2:SUITE K
Practice Address - City:ROBINSON
Practice Address - State:TX
Practice Address - Zip Code:76706-5330
Practice Address - Country:US
Practice Address - Phone:254-732-2262
Practice Address - Fax:254-732-2263
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-14690103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst