Healthcare Provider Details

I. General information

NPI: 1336767433
Provider Name (Legal Business Name): ALEXIS NYEKI HERREID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ARAPAHOE AVE STE 230
BOULDER CO
80302-6752
US

IV. Provider business mailing address

1825 SHALLOT CIR
LAFAYETTE CO
80026-2933
US

V. Phone/Fax

Practice location:
  • Phone: 720-432-4326
  • Fax:
Mailing address:
  • Phone: 760-412-0267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52978
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: