MEDICARE: ALEXA ADAMS LCSW CANDIDATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1174219273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA ADAMS LCSW CANDIDATE

Provider Business Mailing Address
First Line	:	947 E KIRKWOOD DR
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81007-3952
Country	:	US
Telephone Number	:	760-221-8216
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 LAKEWOOD CIR STE A104
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2667
Country	:	US
Telephone Number	:	760-221-8216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2023
Last Update Date	:	04/12/2023

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