Healthcare Provider Details

I. General information

NPI: 1750885364
Provider Name (Legal Business Name): ALEXUS JAKAI SMITH BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17520 OLD JEFFERSON HWY
PRAIRIEVILLE LA
70769-3903
US

IV. Provider business mailing address

1911 STONEGATE CT
BATON ROUGE LA
70815-5467
US

V. Phone/Fax

Practice location:
  • Phone: 225-300-6710
  • Fax: 225-300-6712
Mailing address:
  • Phone: 601-938-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberC-102
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: