Provider Demographics
NPI:1902341506
Name:LEWIS, MICHAL RUTH (MED BCBA)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:RUTH
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 1:3222 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-6860
Mailing Address - Country:US
Mailing Address - Phone:209-768-1033
Mailing Address - Fax:
Practice Address - Street 1:3222 E RACE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-6860
Practice Address - Country:US
Practice Address - Phone:209-768-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-24909103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst