Provider Demographics
NPI:1760057285
Name:LEWIS, ANDREW (BCBA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 GRAND TERRACE CIR S
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-7321
Mailing Address - Country:US
Mailing Address - Phone:251-422-7966
Mailing Address - Fax:
Practice Address - Street 1:5465 ABLE CT
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3100
Practice Address - Country:US
Practice Address - Phone:251-644-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL103K00000X
AL2024-078106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst