Basic Information
| Provider Information | |||||||||
| NPI: | 1255812988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECK | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | EVELYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1551 SHOUP CT | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300334607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047273964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1551 SHOUP CT | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300334607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047273964 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 12043842 | GA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.