Provider Demographics
NPI:1770242471
Name:GIRD, LEXI (MS, TLLP)
Entity Type:Individual
Prefix:
First Name:LEXI
Middle Name:
Last Name:GIRD
Suffix:
Gender:F
Credentials:MS, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 WASHTENAW RD APT 3
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2161
Mailing Address - Country:US
Mailing Address - Phone:248-720-8961
Mailing Address - Fax:
Practice Address - Street 1:127 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2619
Practice Address - Country:US
Practice Address - Phone:734-682-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009437103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical