Provider Demographics
NPI:1134854516
Name:LENARDOS, ALEXIS
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LENARDOS
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 1:116 7TH STREET AVENUE NW
Mailing Address - Street 2:ST 201
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720
Mailing Address - Country:US
Mailing Address - Phone:234-209-9686
Mailing Address - Fax:234-209-9686
Practice Address - Street 1:116 7TH STREET AVENUE NW
Practice Address - Street 2:ST 201
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:234-209-9686
Practice Address - Fax:234-209-9686
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCT.2204137-TRNE101Y00000X
OHC.2305591101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor