Provider Demographics
NPI:1043860091
Name:ELLIOTT, ALEXIS ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANN
Last Name:ELLIOTT
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 1:723 AVONDALE ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5580
Mailing Address - Country:US
Mailing Address - Phone:989-415-3258
Mailing Address - Fax:
Practice Address - Street 1:3865 WILDER RD STE 8
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2136
Practice Address - Country:US
Practice Address - Phone:989-324-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician