Healthcare Provider Details

I. General information

NPI: 1568954980
Provider Name (Legal Business Name): ALEXIS MARIE DANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PRATT RD
METAMORA MI
48455-8910
US

IV. Provider business mailing address

250 2ND ST
LAPEER MI
48446-1445
US

V. Phone/Fax

Practice location:
  • Phone: 810-538-2345
  • Fax:
Mailing address:
  • Phone: 810-667-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851118547
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: