=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114497328
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXA LEIGH MULEE MS, LMHC, CASACT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2018
-----------------------------------------------------
Last Update Date | 11/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 W 34TH ST PH
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-3006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-947-7111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2367 FREDERICK DOUGLASS BLVD APT 2A
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-1808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-830-4001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 009173
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------