MEDICARE: ALEXIS ENRIGHT IMFT

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	106H00000X	Marriage & Family Therapist	F.1900091	OH

General Provider Information

NPI Number	:	1215594411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS ENRIGHT IMFT

Provider Business Mailing Address
First Line	:	PO BOX 94
Second Line	:
City	:	OTTAWA
State	:	IL
Zip	:	61350-0094
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	843 N CLEVELAND MASSILLON RD STE 6
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-2184
Country	:	US
Telephone Number	:	330-723-7977
Fax Number	:	330-725-5177

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

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	11/27/2023

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