Provider Demographics
NPI:1417185810
Name:ALEXANDER, ALEXIS M
Entity Type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:M
Last Name:ALEXANDER
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 1:600 E BASELINE RD
Mailing Address - Street 2:B-2
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1247
Mailing Address - Country:US
Mailing Address - Phone:520-610-3258
Mailing Address - Fax:
Practice Address - Street 1:600 E BASELINE RD
Practice Address - Street 2:B-2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1247
Practice Address - Country:US
Practice Address - Phone:520-610-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ-12923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional