MEDICARE: MS. ALEXIS CALDWELL MHR, LADC, LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1699923458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXIS CALDWELL MHR, LADC, LCSW

Provider Business Mailing Address
First Line	:	3909 SE 29TH ST STE 120
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-2615
Country	:	US
Telephone Number	:	405-588-7817
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 SE 29TH ST STE 120
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-2615
Country	:	US
Telephone Number	:	405-588-7817
Fax Number	:

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

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	01/03/2025

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