Provider Demographics
NPI:1043788151
Name:CORREA, ALEXIS
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 N PALM AVE
Mailing Address - Street 2:PMB 303
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704
Mailing Address - Country:US
Mailing Address - Phone:559-492-7900
Mailing Address - Fax:559-570-0222
Practice Address - Street 1:4152 W SWIFT AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6388
Practice Address - Country:US
Practice Address - Phone:559-475-7860
Practice Address - Fax:559-570-0222
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician