Provider Demographics
NPI:1831797117
Name:EVERS, ALEXIS BRIANNE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BRIANNE
Last Name:EVERS
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 1:3057 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-9250
Mailing Address - Country:US
Mailing Address - Phone:989-630-3709
Mailing Address - Fax:
Practice Address - Street 1:3771 N MISSION RD
Practice Address - Street 2:
Practice Address - City:ROSEBUSH
Practice Address - State:MI
Practice Address - Zip Code:48878-8749
Practice Address - Country:US
Practice Address - Phone:989-433-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-07-3468106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician