Provider Demographics
NPI:1194436741
Name:RECINOS, AXELY
Entity type:Individual
Prefix:
First Name:AXELY
Middle Name:
Last Name:RECINOS
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 1:3060 NE MCWILLIAMS RD TRLR 132
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9586
Mailing Address - Country:US
Mailing Address - Phone:360-473-9189
Mailing Address - Fax:
Practice Address - Street 1:3100 NW BUCKLIN HILL RD STE 215
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8363
Practice Address - Country:US
Practice Address - Phone:360-337-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician