Provider Demographics
NPI:1902255284
Name:TERPSTRA, ALEXIS (BCBA, PSYS)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:TERPSTRA
Suffix:
Gender:F
Credentials:BCBA, PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MASON ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1331
Mailing Address - Country:US
Mailing Address - Phone:616-558-2885
Mailing Address - Fax:
Practice Address - Street 1:2930 KNAPP ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4518
Practice Address - Country:US
Practice Address - Phone:616-558-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBACB354690103K00000X
MISP0000001061481103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst