Provider Demographics
NPI:1164963856
Name:MENDEZ, ALEXIS JOVANN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JOVANN
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Practice Address - Street 2:SUITE T200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3002
Practice Address - Country:US
Practice Address - Phone:470-839-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN