Provider Demographics
NPI:1922491703
Name:EXSTED, ALICIA ANN (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:EXSTED
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ANN
Other - Last Name:ROBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:1370 MENDOTA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1281
Mailing Address - Country:US
Mailing Address - Phone:651-764-7245
Mailing Address - Fax:651-925-0610
Practice Address - Street 1:1370 MENDOTA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1281
Practice Address - Country:US
Practice Address - Phone:651-764-7245
Practice Address - Fax:651-925-0610
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN926101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health