Provider Demographics
NPI:1932698669
Name:TERRY, ALEXIS J (LLPC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:J
Last Name:TERRY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 CONNER ST STE 2210
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3496
Mailing Address - Country:US
Mailing Address - Phone:313-579-4400
Mailing Address - Fax:313-579-4169
Practice Address - Street 1:5555 CONNER ST STE 2210
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3496
Practice Address - Country:US
Practice Address - Phone:313-579-4400
Practice Address - Fax:313-579-4169
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014188101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor