Provider Demographics
NPI:1801543038
Name:ALLEN, ELEXIS YVONNE
Entity type:Individual
Prefix:
First Name:ELEXIS
Middle Name:YVONNE
Last Name:ALLEN
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 1:1900 E VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-7151
Mailing Address - Country:US
Mailing Address - Phone:603-484-9934
Mailing Address - Fax:
Practice Address - Street 1:1900 E VALENCIA DR
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-7151
Practice Address - Country:US
Practice Address - Phone:603-484-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHRBT-20-134307103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1801543038Medicaid
NHNHL14601705Medicaid