Basic Information
| Provider Information | |||||||||
| NPI: | 1689923997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | ALEXIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 UNIVERSITY AVE EAST | ||||||||
| Address2: | SUITE A-127 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 402 UNIVERSITY AVE EAST | ||||||||
| Address2: | SUITE A-127 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2012 | ||||||||
| LastUpdateDate: | 08/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 481 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.