Individual
TREVOR LEE EWING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2036 JACKSON ST, ALEXANDRIA, LA 71301-6439
(318) 641-0444
Mailing address
2036 JACKSON ST, ALEXANDRIA, LA 71301-6439
(318) 641-0444
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
R-4162
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R-4162
REGISTERED LINE TECHNICIAN
LA
Enumeration date
07/27/2021
Last updated
07/27/2021
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