Provider Demographics
NPI:1326870460
Name:ROBERTS, ALEXIS BREANNA
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:BREANNA
Last Name:ROBERTS
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 1:732 BARCELONA CT
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3328
Mailing Address - Country:US
Mailing Address - Phone:205-899-1095
Mailing Address - Fax:
Practice Address - Street 1:732 BARCELONA CT
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3328
Practice Address - Country:US
Practice Address - Phone:205-899-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician