Healthcare Provider Details

I. General information

NPI: 1407348428
Provider Name (Legal Business Name): ALEXANDER JUSTIN REICHSFELD RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21045 N 9TH PL STE 204
PHOENIX AZ
85024-5635
US

IV. Provider business mailing address

21045 N 9TH PL STE 204
PHOENIX AZ
85024-5635
US

V. Phone/Fax

Practice location:
  • Phone: 602-726-2300
  • Fax:
Mailing address:
  • Phone: 602-726-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001178
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: