Provider Demographics
NPI:1912476573
Name:SCHULENBURG, ALEXIS NATASHA WITKIN
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NATASHA WITKIN
Last Name:SCHULENBURG
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 1:4825 TROUSDALE DR STE 216
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-1307
Mailing Address - Country:US
Mailing Address - Phone:615-431-9776
Mailing Address - Fax:
Practice Address - Street 1:4825 TROUSDALE DR STE 216
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1307
Practice Address - Country:US
Practice Address - Phone:615-431-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN429103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst