Healthcare Provider Details

I. General information

NPI: 1558071803
Provider Name (Legal Business Name): ALEXIS SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 IVY POINTE BLVD
CINCINNATI OH
45245-1767
US

IV. Provider business mailing address

4315 IVY POINTE BLVD
CINCINNATI OH
45245-1767
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-2326
  • Fax: 513-803-1111
Mailing address:
  • Phone: 513-636-2326
  • Fax: 513-803-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.08810
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08810
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: