MEDICARE: DR. ALEXIS FAISON PHD, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LAC22485	AZ

General Provider Information

NPI Number	:	1568327997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS FAISON PHD, LAC

Provider Business Mailing Address
First Line	:	39889 W GANLY WAY
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-5939
Country	:	US
Telephone Number	:	336-293-3218
Fax Number	:

Provider Business Practice Location Address
First Line	:	39889 W GANLY WAY
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-5939
Country	:	US
Telephone Number	:	336-293-3218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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Directions to “ DR. ALEXIS FAISON PHD, LAC” Practice Location

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