Provider Demographics
NPI:1881495059
Name:JOHNSON, ALEXIS DESHAE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DESHAE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 ALABONSON RD APT 205
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-5346
Mailing Address - Country:US
Mailing Address - Phone:281-731-9033
Mailing Address - Fax:
Practice Address - Street 1:7302 ALABONSON RD APT 205
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-5346
Practice Address - Country:US
Practice Address - Phone:281-731-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-366924106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician