Provider Demographics
NPI:1023698206
Name:COUGHLIN, ALEXIS NICOLE
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:NICOLE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TWIN ISLES RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3739
Mailing Address - Country:US
Mailing Address - Phone:603-339-2836
Mailing Address - Fax:
Practice Address - Street 1:3 TWIN ISLES RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3739
Practice Address - Country:US
Practice Address - Phone:603-339-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty