=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801610498
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXIS REISHER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2024
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 ROUTE 34 STE 106
-----------------------------------------------------
City | COLTS NECK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07722-2444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-648-6423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64 DANELLA WAY
-----------------------------------------------------
City | HOWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07731-8917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-618-0287
-----------------------------------------------------
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 | 37AC00839200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------