MEDICARE: ALEXA FARRIS

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	101Y00000X	Counselor		WA
2	101YM0800X	Mental Health Counselor	LH61451416	WA

General Provider Information

NPI Number	:	1669083663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA FARRIS

Provider Business Mailing Address
First Line	:	3965 BETHEL RD SE
Second Line	:	STE 1 #303
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366
Country	:	US
Telephone Number	:	306-592-3359
Fax Number	:

Provider Business Practice Location Address
First Line	:	2507 SE MILE HILL DR STE C-108
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3515
Country	:	US
Telephone Number	:	360-592-3359
Fax Number	:	360-519-5170

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

Provider Enumeration Date	:	08/12/2020
Last Update Date	:	10/14/2024

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Directions to “ ALEXA FARRIS ” Practice Location

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