Provider Demographics
NPI:1740584788
Name:ALLENSWORTH, ALEXIS K (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:K
Last Name:ALLENSWORTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SKY PARK DR STE 206
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5889
Mailing Address - Country:US
Mailing Address - Phone:541-838-1227
Mailing Address - Fax:541-210-9057
Practice Address - Street 1:1600 SKY PARK DR STE 206
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5889
Practice Address - Country:US
Practice Address - Phone:541-838-1227
Practice Address - Fax:541-838-1227
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC3286101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health