Healthcare Provider Details

I. General information

NPI: 1760398903
Provider Name (Legal Business Name): ALEXIS TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 5TH AVE
WORTHINGTON MN
56187-2432
US

IV. Provider business mailing address

7223 E CORNERSTONE PL UNIT 4
SIOUX FALLS SD
57110-4094
US

V. Phone/Fax

Practice location:
  • Phone: 507-376-4141
  • Fax: 507-376-4494
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number307490
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5805
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: