Healthcare Provider Details

I. General information

NPI: 1801533450
Provider Name (Legal Business Name): ALEXIS FARLEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 PROVIDENCE BLVD STE R #1093
DELTONA FL
32725
US

IV. Provider business mailing address

1235 PROVIDENCE BLVD STE R #1093
DELTONA FL
32725
US

V. Phone/Fax

Practice location:
  • Phone: 561-716-9144
  • Fax:
Mailing address:
  • Phone: 561-716-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5058
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: