Healthcare Provider Details

I. General information

NPI: 1164090643
Provider Name (Legal Business Name): MR. ALEXIS MARQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 09/25/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARROUSEL THERAPY CENTER 3201 BUDIGER AVENUE
SAINT CLOUD FL
34769
US

IV. Provider business mailing address

3120 QUEEN ALEXANDRIA DR
KISSIMMEE FL
34744-9108
US

V. Phone/Fax

Practice location:
  • Phone: 407-910-2941
  • Fax:
Mailing address:
  • Phone: 407-716-8943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: