Healthcare Provider Details

I. General information

NPI: 1477464451
Provider Name (Legal Business Name): ALEXIS CUSHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 W 47TH ST
SIOUX FALLS SD
57106-6345
US

IV. Provider business mailing address

3409 W 47TH ST
SIOUX FALLS SD
57106-6345
US

V. Phone/Fax

Practice location:
  • Phone: 605-593-4075
  • Fax: 605-401-4086
Mailing address:
  • Phone: 605-593-4075
  • Fax: 605-401-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC21072
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: