Provider Demographics
NPI:1609469592
Name:PASCARELLA, ALEXIS JORDAN (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JORDAN
Last Name:PASCARELLA
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:JORDAN
Other - Last Name:MELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 S GILBERT RD APT 3043
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-0452
Mailing Address - Country:US
Mailing Address - Phone:815-715-6848
Mailing Address - Fax:
Practice Address - Street 1:5570 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3697
Practice Address - Country:US
Practice Address - Phone:480-608-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-20-46673103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst