Provider Demographics
NPI:1245772185
Name:MOULAGIANNIS, ALEXANDRA G (LPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:G
Last Name:MOULAGIANNIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29133 HEALTH CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5256
Mailing Address - Country:US
Mailing Address - Phone:440-835-6212
Mailing Address - Fax:
Practice Address - Street 1:29133 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5256
Practice Address - Country:US
Practice Address - Phone:440-835-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional