Healthcare Provider Details

I. General information

NPI: 1578132072
Provider Name (Legal Business Name): ALEXA RAE PATRICK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 SAGEBRUSH TRL
CROSS ROADS TX
76227-3826
US

IV. Provider business mailing address

101 S LOCUST ST STE 602
DENTON TX
76201-6159
US

V. Phone/Fax

Practice location:
  • Phone: 512-956-6463
  • Fax:
Mailing address:
  • Phone: 512-956-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number86214
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: