Healthcare Provider Details

I. General information

NPI: 1346858875
Provider Name (Legal Business Name): ALEXIS VUKELICH MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS MOORE

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 MOUNT PLEASANT RD
KINGSTON SPRINGS TN
37082-9081
US

IV. Provider business mailing address

584 MOUNT PLEASANT RD
KINGSTON SPRINGS TN
37082-9081
US

V. Phone/Fax

Practice location:
  • Phone: 615-579-4910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57776
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: