Provider Demographics
NPI:1407576788
Name:PROFFITT, ALEXCIA
Entity Type:Individual
Prefix:
First Name:ALEXCIA
Middle Name:
Last Name:PROFFITT
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 1:5143 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1825
Mailing Address - Country:US
Mailing Address - Phone:913-475-1095
Mailing Address - Fax:
Practice Address - Street 1:8819 LONG ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3585
Practice Address - Country:US
Practice Address - Phone:913-475-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-22-203083103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst