Provider Demographics
NPI:1235910654
Name:MCLEOD HALL, ALEXIS JASMINE
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:JASMINE
Last Name:MCLEOD HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4430
Mailing Address - Country:US
Mailing Address - Phone:909-965-0025
Mailing Address - Fax:
Practice Address - Street 1:110 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94611-4430
Practice Address - Country:US
Practice Address - Phone:909-965-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1183681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical