Provider Demographics
NPI:1033516984
Name:ALEXANDER, LETTIE KATHERINE (BCBA)
Entity Type:Individual
Prefix:
First Name:LETTIE
Middle Name:KATHERINE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 MENARD RD
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-8183
Mailing Address - Country:US
Mailing Address - Phone:337-563-1854
Mailing Address - Fax:
Practice Address - Street 1:4205 RYAN ST
Practice Address - Street 2:BOX 91895
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70609-1895
Practice Address - Country:US
Practice Address - Phone:337-562-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-088103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst