Provider Demographics
NPI:1568911642
Name:REYNA, ALEXIS RUBY (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RUBY
Last Name:REYNA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 PAINTERSVILLE NEW JASP RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-8406
Mailing Address - Country:US
Mailing Address - Phone:937-768-5536
Mailing Address - Fax:
Practice Address - Street 1:2522 NUTTER PARK DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-3500
Practice Address - Country:US
Practice Address - Phone:937-306-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-16-23272103K00000X
TX1-16-23272103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst