Basic Information
| Provider Information | |||||||||
| NPI: | 1912485186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6102 82ND ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794240802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8069993333 | ||||||||
| FaxNumber: | 4693740800 | ||||||||
| Practice Location | |||||||||
| Address1: | 6102 82ND ST STE 10 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8069993333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2018 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-21-51176 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | RBT-17-42167 | 01 | TX | BACB | OTHER | BCBA-1-21-51176 | 01 | TX | BACB | OTHER |