Provider Demographics
NPI:1366926289
Name:VANN, ALEXSHA DIANE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ALEXSHA
Middle Name:DIANE
Last Name:VANN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:ALEXSHA
Other - Middle Name:DIANE
Other - Last Name:PLAGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 S SHERMAN ST STE 113
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-4012
Mailing Address - Country:US
Mailing Address - Phone:469-522-9867
Mailing Address - Fax:469-519-2365
Practice Address - Street 1:401 S SHERMAN ST STE 113
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-4012
Practice Address - Country:US
Practice Address - Phone:469-522-9867
Practice Address - Fax:469-519-2365
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2213103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst