Provider Demographics
NPI:1851412456
Name:TAUBERT, ALEXIS LYBROOK (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:LYBROOK
Last Name:TAUBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W DIVISION ST
Mailing Address - Street 2:#4B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3426
Mailing Address - Country:US
Mailing Address - Phone:773-248-4544
Mailing Address - Fax:773-227-2598
Practice Address - Street 1:1850 W DIVISION ST
Practice Address - Street 2:#4B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3426
Practice Address - Country:US
Practice Address - Phone:773-248-4544
Practice Address - Fax:773-227-2598
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical