Provider Demographics
NPI:1770968844
Name:LEWIS, KAYANA IEISHA-MARIE (MS)
Entity type:Individual
Prefix:
First Name:KAYANA
Middle Name:IEISHA-MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KAYANA
Other - Middle Name:IEISHA-MARIE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3016 W CHARLESTON BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1963
Mailing Address - Country:US
Mailing Address - Phone:702-780-2315
Mailing Address - Fax:702-895-4014
Practice Address - Street 1:630 S RANCHO DR STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4849
Practice Address - Country:US
Practice Address - Phone:702-998-9505
Practice Address - Fax:702-527-7939
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NVRBT-18-52418106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT-18-52418OtherBEHAVIOR ANALYST CERTIFICATION BOARD
NV1770968844Medicaid