Healthcare Provider Details

I. General information

NPI: 1003476284
Provider Name (Legal Business Name): ALEXIS MALONE WOOLERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIS JORDAN MALONE

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 08/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMPOWER BEHAVIORAL HEALTH AND INTERVENTION 2540 BILLINGSLEY RD
COLUMBUS OH
43235-1990
US

IV. Provider business mailing address

3070 RIVERSIDE DR STE 200
COLUMBUS OH
43221-2547
US

V. Phone/Fax

Practice location:
  • Phone: 614-470-2018
  • Fax: 614-953-2802
Mailing address:
  • Phone: 614-615-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: