Healthcare Provider Details

I. General information

NPI: 1629939855
Provider Name (Legal Business Name): ALEXIS CORMIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 NEW HIGHWAY 51 STE C
LA PLACE LA
70068-6512
US

IV. Provider business mailing address

1732 BRIGHTSIDE DR APT C
BATON ROUGE LA
70820-1728
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-1809
  • Fax: 985-652-1809
Mailing address:
  • Phone: 225-407-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: