Provider Demographics
NPI:1922780253
Name:ALEXIS LANE LLC
Entity Type:Organization
Organization Name:ALEXIS LANE LLC
Other - Org Name:GROWTHROUGHIT808
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-291-0978
Mailing Address - Street 1:1524 PENSACOLA ST APT 304
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3834
Mailing Address - Country:US
Mailing Address - Phone:808-226-0076
Mailing Address - Fax:
Practice Address - Street 1:1524 PENSACOLA ST APT 304
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3834
Practice Address - Country:US
Practice Address - Phone:808-226-0076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty