Provider Demographics
NPI:1851905467
Name:ALEXANDER, SHANITA
Entity Type:Individual
Prefix:
First Name:SHANITA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:12215 GILESPIE ST UNIT 17207
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-8814
Mailing Address - Country:US
Mailing Address - Phone:219-713-0340
Mailing Address - Fax:
Practice Address - Street 1:12215 GILESPIE ST UNIT 17207
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-8814
Practice Address - Country:US
Practice Address - Phone:219-713-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst