Provider Demographics
NPI:1003322389
Name:SPENCE, ELEXIS (BCABA, RBT)
Entity type:Individual
Prefix:
First Name:ELEXIS
Middle Name:
Last Name:SPENCE
Suffix:
Gender:F
Credentials:BCABA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KAHELU AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3913
Mailing Address - Country:US
Mailing Address - Phone:808-625-3000
Mailing Address - Fax:
Practice Address - Street 1:100 KAHELU AVE STE 112
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3913
Practice Address - Country:US
Practice Address - Phone:808-625-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-16-15071106S00000X
HI0-24-15184106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty