Provider Demographics
NPI:1104205194
Name:BOREMAN-MENKE, ALICIA (LPC/CR)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:BOREMAN-MENKE
Suffix:
Gender:F
Credentials:LPC/CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 BERDAN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4805
Mailing Address - Country:US
Mailing Address - Phone:419-819-8428
Mailing Address - Fax:
Practice Address - Street 1:5647 MAYBERRY SQUARE
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9456
Practice Address - Country:US
Practice Address - Phone:419-819-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400233-CR101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health