Healthcare Provider Details

I. General information

NPI: 1902430119
Provider Name (Legal Business Name): ALEXIS W INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 KALAMAZOO AVE SE STE C
CALEDONIA MI
49316-9197
US

IV. Provider business mailing address

7150 KALAMAZOO AVE SE STE C
CALEDONIA MI
49316-9197
US

V. Phone/Fax

Practice location:
  • Phone: 616-219-0159
  • Fax: 616-219-0124
Mailing address:
  • Phone: 616-219-0159
  • Fax: 616-219-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEXIS KARAMOL
Title or Position: PRESIDENT
Credential: MA LLP
Phone: 616-915-4213