Provider Demographics
NPI:1659186815
Name:BANUELOS, ALEX M
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:M
Last Name:BANUELOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 DELPHINIUM LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3640
Mailing Address - Country:US
Mailing Address - Phone:308-293-8239
Mailing Address - Fax:
Practice Address - Street 1:8625 DELPHINIUM LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-3640
Practice Address - Country:US
Practice Address - Phone:308-293-8239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker