Healthcare Provider Details

I. General information

NPI: 1780572305
Provider Name (Legal Business Name): ALEXIS IDE BUCIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 13TH ST
MERCED CA
95341-6211
US

IV. Provider business mailing address

208 HONEYBELL CT
LOS BANOS CA
93635-6399
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-6800
  • Fax:
Mailing address:
  • Phone: 209-619-7163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACSW129248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: