Provider Demographics
NPI:1982334900
Name:ALBA, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:ALBA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 S BASSWOOD DR APT F
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2896
Mailing Address - Country:US
Mailing Address - Phone:765-430-3435
Mailing Address - Fax:
Practice Address - Street 1:790 S BASSWOOD DR APT F
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2896
Practice Address - Country:US
Practice Address - Phone:765-430-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2025-03-18
Deactivation Date:2024-06-23
Deactivation Code:
Reactivation Date:2025-03-18
Provider Licenses
StateLicense IDTaxonomies
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician