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General NPI Number Information
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NPI Number | 1922771997
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Entity Type | Individual
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Provider Name | ALEXIS D MUSGROVE
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Gender | Female
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 165 E PARK AVE
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City | NILES
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State | OH
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Zip | 44446-2352
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Country | US
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Telephone | 330-544-8005
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Fax | 330-544-9379
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Provider Business Mailing Address
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Address Line | 3221 LODWICK DR NW APT 5
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City | WARREN
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State | OH
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Zip | 44485-1562
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Country | US
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Telephone | 412-863-8966
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2304905
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License Number State | OH
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