Healthcare Provider Details

I. General information

NPI: 1467096990
Provider Name (Legal Business Name): ALEXA J ANDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST
ADRIAN MI
49221-1759
US

IV. Provider business mailing address

1200 N MAIN ST
ADRIAN MI
49221-1759
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-1800
  • Fax: 517-263-1866
Mailing address:
  • Phone: 517-263-1800
  • Fax: 517-263-1866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401017778
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401222417
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: