Provider Demographics
NPI:1295214385
Name:PICKERING, ALEXA (LSCSW, LMAC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:PICKERING
Suffix:
Gender:F
Credentials:LSCSW, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 HARRISON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1493
Mailing Address - Country:US
Mailing Address - Phone:515-351-7033
Mailing Address - Fax:
Practice Address - Street 1:12616 W 62ND TER STE 119
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1811
Practice Address - Country:US
Practice Address - Phone:816-701-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
50501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker