Healthcare Provider Details

I. General information

NPI: 1659022747
Provider Name (Legal Business Name): ALEXIS BYNUM LPMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GARRISON CT APT 403
HISTORIC NEW CASTLE DE
19720-4479
US

IV. Provider business mailing address

800 GARRISON CT APT 403
HISTORIC NEW CASTLE DE
19720-4479
US

V. Phone/Fax

Practice location:
  • Phone: 302-668-5284
  • Fax:
Mailing address:
  • Phone: 302-668-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0011507
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: