Provider Demographics
NPI:1598470841
Name:ALEXIS, JAMESON
Entity Type:Individual
Prefix:
First Name:JAMESON
Middle Name:
Last Name:ALEXIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S STATE ROAD 7 STE 174
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4306
Mailing Address - Country:US
Mailing Address - Phone:561-785-7688
Mailing Address - Fax:
Practice Address - Street 1:420 S STATE RD
Practice Address - Street 2:174
Practice Address - City:ROYAL PALM
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-785-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician