Healthcare Provider Details

I. General information

NPI: 1275613101
Provider Name (Legal Business Name): ALEXIS REED SR. L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 NE LAKEWOOD WAY STE 130
LEES SUMMIT MO
64064-1995
US

IV. Provider business mailing address

1116 SE COUNTRY LN
LEES SUMMIT MO
64081-3094
US

V. Phone/Fax

Practice location:
  • Phone: 816-886-2184
  • Fax: 816-886-2397
Mailing address:
  • Phone: 816-721-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004024488
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: