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NPI Code Detail

MEDICARE: TALISE N ALEXIE AS

MEDICARE:   TALISE N ALEXIE  AS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1629597257
Entity Type Code : Individual
Provider Name (Legal Business Name) : TALISE N ALEXIE AS
Provider Business Mailing Address
First Line : 350 GATEWAY DR
Second Line :
City : SLIDELL
State : LA
Zip : 70461-5589
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 350 GATEWAY DR
Second Line :
City : SLIDELL
State : LA
Zip : 70461-5589
Country : US
Telephone Number : 985-707-1010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2017
Last Update Date : 09/14/2017

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Directions to “ TALISE N ALEXIE AS” Practice Location

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