Provider Demographics
NPI:1790308773
Name:EDWARDS, ALEXIS NICOLE
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:NICOLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MEADOWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3729
Mailing Address - Country:US
Mailing Address - Phone:314-600-7605
Mailing Address - Fax:
Practice Address - Street 1:3155 SNOW TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9204
Practice Address - Country:US
Practice Address - Phone:720-295-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician