Provider Demographics
NPI:1033994165
Name:KAWLICHE, ALEX (LMHC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:KAWLICHE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15017 N DALE MABRY HWY # 1049
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1816
Mailing Address - Country:US
Mailing Address - Phone:813-816-3300
Mailing Address - Fax:
Practice Address - Street 1:16554 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1325
Practice Address - Country:US
Practice Address - Phone:813-816-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health