Provider Demographics
NPI:1518442458
Name:AUCKENTHALER, ALEXIS (MSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:AUCKENTHALER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 CALIFORNIA AVE # 247
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1650
Mailing Address - Country:US
Mailing Address - Phone:530-414-6719
Mailing Address - Fax:
Practice Address - Street 1:10121 PINE AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4835
Practice Address - Country:US
Practice Address - Phone:530-587-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5984-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker