Provider Demographics
NPI:1730692211
Name:OLLES, ALEXANDRA VICTORIA
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:VICTORIA
Last Name:OLLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:VICTORIA
Other - Last Name:OLLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCABA, BCBA
Mailing Address - Street 1:7964 OAK RUN CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-7252
Mailing Address - Country:US
Mailing Address - Phone:352-777-5766
Mailing Address - Fax:
Practice Address - Street 1:7964 OAK RUN CIR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-7252
Practice Address - Country:US
Practice Address - Phone:352-777-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
FL1-21-52422103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst