Provider Demographics
NPI:1003602616
Name:LISLE, ALEXIS E (QMHA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:E
Last Name:LISLE
Suffix:
Gender:
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 NE SANDY BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2791
Mailing Address - Country:US
Mailing Address - Phone:971-940-2601
Mailing Address - Fax:
Practice Address - Street 1:1785 NE SANDY BLVD STE 270
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2791
Practice Address - Country:US
Practice Address - Phone:971-940-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program