Healthcare Provider Details

I. General information

NPI: 1871076745
Provider Name (Legal Business Name): ALEXIS CHARNE TAYLOR MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4177 RAINBOW DR
DECATUR GA
30034-2224
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 248-220-7980
  • Fax:
Mailing address:
  • Phone: 855-324-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-46714
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: