Provider Demographics
NPI:1649762220
Name:POWERS, ALEXIS (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:POWERS
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 1:848 PRINCESS DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4624
Mailing Address - Country:US
Mailing Address - Phone:267-994-3495
Mailing Address - Fax:
Practice Address - Street 1:2525 S WADSWORTH BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3246
Practice Address - Country:US
Practice Address - Phone:720-962-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-17-28767103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst