Provider Demographics
NPI:1508552605
Name:JEANLOUIS, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:JEANLOUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 DIANE AVE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6419
Mailing Address - Country:US
Mailing Address - Phone:321-557-7219
Mailing Address - Fax:321-241-2972
Practice Address - Street 1:2738 DIANE AVE SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6419
Practice Address - Country:US
Practice Address - Phone:321-557-7219
Practice Address - Fax:321-241-2972
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical