Provider Demographics
NPI:1932617875
Name:WORKMAN, MARY ALEXANDRA (RBT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALEXANDRA
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ALEXANDRA
Other - Last Name:BOHANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:50 COUNTRY TRL
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72131-8698
Mailing Address - Country:US
Mailing Address - Phone:501-691-2009
Mailing Address - Fax:
Practice Address - Street 1:1301 MUSEUM RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4739
Practice Address - Country:US
Practice Address - Phone:501-358-6535
Practice Address - Fax:501-358-6536
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
AR1-22-60280103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician