Provider Demographics
NPI:1295302826
Name:ELFONT, ALEX (MS, BCBA, LABA)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:ELFONT
Suffix:
Gender:M
Credentials:MS, BCBA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 E EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5023
Mailing Address - Country:US
Mailing Address - Phone:720-355-1081
Mailing Address - Fax:
Practice Address - Street 1:4400 E EVANS AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5023
Practice Address - Country:US
Practice Address - Phone:720-355-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-21-47399103K00000X
MA3553-MH-B1103K00000X
CO1-21-47399103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst