Healthcare Provider Details

I. General information

NPI: 1205335841
Provider Name (Legal Business Name): ALEXANDRIA MICHELLE MINKLER BS, CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 CINCINNATI BATAVIA PIKE
CINCINNATI OH
45244-1518
US

IV. Provider business mailing address

3839 S STATE ROAD 15
WABASH IN
46992-7975
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax: 513-752-1555
Mailing address:
  • Phone: 260-563-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1700699-TRNE
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: