Provider Demographics
NPI:1447609698
Name:MONTERREY, ALEXIS (BCBA)
Entity Type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:
Last Name:MONTERREY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 KILCOYNE CT
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8035
Mailing Address - Country:US
Mailing Address - Phone:561-592-5290
Mailing Address - Fax:
Practice Address - Street 1:3802 EHRLICH RD STE 304
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2355
Practice Address - Country:US
Practice Address - Phone:561-592-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCABA-0-17-8438106E00000X
FLBCBA-1-22-62643103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018375100Medicaid