Provider Demographics
NPI:1659022747
Name:BYNUM, ALEXIS (LPMHC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BYNUM
Suffix:
Gender:F
Credentials:LPMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GARRISON CT APT 403
Mailing Address - Street 2:
Mailing Address - City:HISTORIC NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4479
Mailing Address - Country:US
Mailing Address - Phone:302-668-5284
Mailing Address - Fax:
Practice Address - Street 1:800 GARRISON CT APT 403
Practice Address - Street 2:
Practice Address - City:HISTORIC NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4479
Practice Address - Country:US
Practice Address - Phone:302-668-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
DE0011507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health