Provider Demographics
NPI:1659697811
Name:ALEXANDER, GISELLE KU'ULEIMOMI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GISELLE
Middle Name:KU'ULEIMOMI
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48450-9379
Mailing Address - Country:US
Mailing Address - Phone:512-809-8109
Mailing Address - Fax:
Practice Address - Street 1:4980 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450-9379
Practice Address - Country:US
Practice Address - Phone:512-809-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50917101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2046674-01Medicaid