Provider Demographics
NPI:1427427939
Name:GANZ, ALEXIS (PSYD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:GANZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 LITTLE OVERLOOK ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-4495
Mailing Address - Country:US
Mailing Address - Phone:714-317-3523
Mailing Address - Fax:
Practice Address - Street 1:5880 STATE HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:CO
Practice Address - Zip Code:81226-9791
Practice Address - Country:US
Practice Address - Phone:719-784-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY5268103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical