Provider Demographics
NPI:1114371655
Name:MUNGAI, ALEXA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:MUNGAI
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 1:3730 ROME TER
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-6718
Mailing Address - Country:US
Mailing Address - Phone:574-261-3984
Mailing Address - Fax:
Practice Address - Street 1:110 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2707
Practice Address - Country:US
Practice Address - Phone:765-481-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0-16-6952103K00000X
1-16-24235103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst