Healthcare Provider Details

I. General information

NPI: 1457790735
Provider Name (Legal Business Name): ALEXIS LEMIEUX LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N HIGHLAND AVE
AURORA IL
60506-3814
US

IV. Provider business mailing address

644 DANA CT UNIT C
NAPERVILLE IL
60563-2467
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-2532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008518
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: