Healthcare Provider Details

I. General information

NPI: 1275442659
Provider Name (Legal Business Name): ALEXIS KIRA MCKELLAR LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 N GRANDVIEW BLVD
WAUKESHA WI
53188-6100
US

IV. Provider business mailing address

200 S WALES RD
WALES WI
53183-9737
US

V. Phone/Fax

Practice location:
  • Phone: 262-547-5567
  • Fax:
Mailing address:
  • Phone: 262-408-1007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9090-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: