Provider Demographics
NPI:1003580960
Name:HUPPERT, ALEXIS JOY (RBT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JOY
Last Name:HUPPERT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 W 134TH CIR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5167
Mailing Address - Country:US
Mailing Address - Phone:303-681-8913
Mailing Address - Fax:
Practice Address - Street 1:716 INDIAN TRL STE 140
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5702
Practice Address - Country:US
Practice Address - Phone:254-213-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBACB704859106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty