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General NPI Number Information
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NPI Number | 1689096471
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Entity Type | Individual
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Provider Name | ALEXIS N CROOK LCSW, MPH, PHD
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Gender | Female
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 4229 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40218-3241
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Country | US
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Telephone | 502-416-4614
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Fax |
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Provider Business Mailing Address
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Address Line | 10219 RIVERSTONE CIR
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City | LOUISVILLE
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State | KY
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Zip | 40229-5228
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Country | US
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Telephone | 502-322-7071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 256460
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License Number State | KY
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