Provider Demographics
NPI:1346779758
Name:LANCASTER, ALIX CHARLOTTE
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:CHARLOTTE
Last Name:LANCASTER
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 1:4139 ARBOLES BONITOS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-1007
Mailing Address - Country:US
Mailing Address - Phone:323-493-0517
Mailing Address - Fax:323-493-0517
Practice Address - Street 1:4139 ARBOLES BONITOS
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-1007
Practice Address - Country:US
Practice Address - Phone:323-493-0517
Practice Address - Fax:323-493-0517
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-57361103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst