Provider Demographics
NPI:1952981573
Name:HAUCK, ALEXIS
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:
Last Name:HAUCK
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 1:6245 OAK MEADOWS BLVD APT F307
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6654
Mailing Address - Country:US
Mailing Address - Phone:513-600-8545
Mailing Address - Fax:
Practice Address - Street 1:6245 OAK MEADOWS BLVD APT F307
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6654
Practice Address - Country:US
Practice Address - Phone:513-600-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016694101YM0800X
CO0015024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health