Provider Demographics
NPI:1003476284
Name:WOOLERY, ALEXIS MALONE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MALONE
Last Name:WOOLERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:JORDAN
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3070 RIVERSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2547
Mailing Address - Country:US
Mailing Address - Phone:614-615-5145
Mailing Address - Fax:
Practice Address - Street 1:EMPOWER BEHAVIORAL HEALTH AND INTERVENTION
Practice Address - Street 2:2540 BILLINGSLEY RD
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1990
Practice Address - Country:US
Practice Address - Phone:614-470-2018
Practice Address - Fax:614-953-2802
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0049884Medicaid