Provider Demographics
NPI:1902317761
Name:MANZO, ALEXIS (BCBA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MANZO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 HOLLAND DR APT G18
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6393
Mailing Address - Country:US
Mailing Address - Phone:586-817-0172
Mailing Address - Fax:
Practice Address - Street 1:348 WARFIELD BLVD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5686
Practice Address - Country:US
Practice Address - Phone:931-553-1395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-26019103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst