Provider Demographics
NPI:1194590323
Name:WHIPPLE, ALEXUS (RBT)
Entity type:Individual
Prefix:
First Name:ALEXUS
Middle Name:
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1845
Mailing Address - Country:US
Mailing Address - Phone:478-845-7516
Mailing Address - Fax:478-292-6463
Practice Address - Street 1:150 N CREST BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1845
Practice Address - Country:US
Practice Address - Phone:478-845-7516
Practice Address - Fax:478-292-6463
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-268843106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician