Provider Demographics
NPI:1295187565
Name:FAVELA, ALEXIS (BHS)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:
Last Name:FAVELA
Suffix:
Gender:F
Credentials:BHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43380 SHASTA PL
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-8937
Mailing Address - Country:US
Mailing Address - Phone:928-446-7854
Mailing Address - Fax:
Practice Address - Street 1:82675 US HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5635
Practice Address - Country:US
Practice Address - Phone:760-393-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator