Provider Demographics
NPI:1336767433
Name:HERREID, ALEXIS NYEKI
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NYEKI
Last Name:HERREID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 SHALLOT CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2933
Mailing Address - Country:US
Mailing Address - Phone:760-412-0267
Mailing Address - Fax:
Practice Address - Street 1:2500 ARAPAHOE AVE STE 230
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6752
Practice Address - Country:US
Practice Address - Phone:720-432-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
CO1-21-52978103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician