Alexandria Booker
Individual provider Active NPI Behavior Analyst · Goshen, IN
NPI 1164065710 · NPPES record last updated Sep 24, 2024
Key facts
- NPI
- 1164065710
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- Practice address
- 2014 Lincolnway E Ste 3
Goshen, IN 46526-6818 - Phone
- (239) 920-3948
- NPI assigned
- Oct 25, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-19-1705-178936 | FL | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Walton Academy, Inc. | Behavior Analyst | Current |
Accepting new patients |
| Emerald Coast Autism Center | Past |
Accepting new patients | |
| Seaside Behavior Services, LLC | Behavior Analyst | Past |
Accepting new patients |
| Virtus Health, LLC | Behavior Analyst | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-23-63495 | ||
| Behavior Technician | 106S00000X | RBT-19-1705-178936 | FL | |
| Behavior Analyst | 103K00000X | Yes |
Addresses
Primary practice location
2014 Lincolnway E Ste 3
Goshen, IN 46526-6818
Mailing address
23756 N Shore Dr
Edwardsburg, MI 49112-9524
Phone (850) 603-4990
Other practice location 1
99 Grande Pointe Cir
Inlet Beach, FL 32461-7379
Phone (850) 896-3873
Other practice location 2
80 College Blvd E
Niceville, FL 32578-1343
Phone (850) 279-3000
Other practice location 3
305 Mack Bayou Rd
Santa Rosa Beach, FL 32459-7199
Phone (850) 213-4595
Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.