Individual
ALEXIS LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1040 N 10TH ST STE 100, KALAMAZOO, MI 49009-6150
(844) 263-1613
Mailing address
2550 N HOLLYWOOD WAY STE 301, BURBANK, CA 91505-5025
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/12/2024
Last updated
08/12/2024
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