MEDICARE: ALEXIS MACKENZIE KRESSNER LMFT

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	12297	NC

General Provider Information

NPI Number	:	1811500929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS MACKENZIE KRESSNER LMFT

Provider Business Mailing Address
First Line	:	2572 CHERBOUGH WAY APT C
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28056-5508
Country	:	US
Telephone Number	:	919-339-3576
Fax Number	:

Provider Business Practice Location Address
First Line	:	6813 FAIRVIEW RD STE C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3364
Country	:	US
Telephone Number	:	980-428-6195
Fax Number	:

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/09/2023

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