Individual
ALEXA SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
4606 S 14TH ST, ABILENE, TX 79605-4735
(325) 704-4392
Mailing address
130 WISE ST, CLYDE, TX 79510-4001
(325) 232-1738
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
19-98876
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-98876
TRICARE
TX
Enumeration date
09/18/2019
Last updated
09/18/2019
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