Provider Demographics
NPI:1043664253
Name:MUTISYA, ALEXIS (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MUTISYA
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 VASSAR ST
Mailing Address - Street 2:STE.3
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3453
Mailing Address - Country:US
Mailing Address - Phone:775-448-6533
Mailing Address - Fax:775-787-2751
Practice Address - Street 1:2440 VASSAR ST
Practice Address - Street 2:STE.3
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3453
Practice Address - Country:US
Practice Address - Phone:775-448-6533
Practice Address - Fax:775-787-2751
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-15-03062103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst