Provider Demographics
NPI:1053179416
Name:LEWIS, BRANDI NICHOLE (MA, MPM, QIDP, QMHA)
Entity type:Individual
Prefix:MISS
First Name:BRANDI
Middle Name:NICHOLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, MPM, QIDP, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 N RANCHO DR STE 104A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3361
Mailing Address - Country:US
Mailing Address - Phone:480-795-0209
Mailing Address - Fax:
Practice Address - Street 1:2580 N RANCHO DR STE 104A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3361
Practice Address - Country:US
Practice Address - Phone:480-795-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician