Provider Demographics
NPI:1336853456
Name:MACHELOR, ALEXIS MARY
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARY
Last Name:MACHELOR
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 1:1050 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2001
Mailing Address - Country:US
Mailing Address - Phone:716-218-2100
Mailing Address - Fax:716-856-2608
Practice Address - Street 1:1050 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2001
Practice Address - Country:US
Practice Address - Phone:716-218-2100
Practice Address - Fax:716-856-2608
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
112520101Y00000X, 225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
112520OtherCOMMISSION ON REHABILITATION COUNSELOR CERTIFICATION