Provider Demographics
NPI:1225643828
Name:SABLE, ALEXIS MARY
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARY
Last Name:SABLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S BROADWAY STE 16
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4667
Mailing Address - Country:US
Mailing Address - Phone:701-852-6154
Mailing Address - Fax:701-248-7303
Practice Address - Street 1:1015 S BROADWAY STE 16
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4667
Practice Address - Country:US
Practice Address - Phone:701-852-6154
Practice Address - Fax:701-248-7303
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician