Healthcare Provider Details

I. General information

NPI: 1295302826
Provider Name (Legal Business Name): ALEX ELFONT MS, BCBA, LABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 E EVANS AVE
DENVER CO
80222-5023
US

IV. Provider business mailing address

4400 E EVANS AVE
DENVER CO
80222-5023
US

V. Phone/Fax

Practice location:
  • Phone: 720-355-1081
  • Fax:
Mailing address:
  • Phone: 720-355-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47399
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3553-MH-B1
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47399
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: