Provider Demographics
NPI:1043960297
Name:GRAHAM, ALEXIS ISABELLA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ISABELLA
Last Name:GRAHAM
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 1:3800 HARRISBURG RD APT 1002
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9182
Mailing Address - Country:US
Mailing Address - Phone:870-815-0683
Mailing Address - Fax:
Practice Address - Street 1:3800 HARRISBURG RD APT 1002
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9182
Practice Address - Country:US
Practice Address - Phone:879-815-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12258246103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst