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NPI Code Detail

MEDICARE: ALEXA GLICK BCBA

MEDICARE: ALEXA GLICK BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-20-40526NM

General Provider Information

NPI Number : 1871995597
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXA GLICK BCBA
Provider Business Mailing Address
First Line : 5532 BARRANCA OVERLOOK CT NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-2646
Country : US
Telephone Number : 630-862-4736
Fax Number :
Provider Business Practice Location Address
First Line : 277 E AMADOR AVE STE 101
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-3675
Country : US
Telephone Number : 505-584-2634
Fax Number : 505-718-3160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2014
Last Update Date : 05/08/2025

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