Provider Demographics
NPI:1902430119
Name:ALEXIS W INCORPORATED
Entity Type:Organization
Organization Name:ALEXIS W INCORPORATED
Other - Org Name:CARDINAL COUNSELING & ASSESSMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAMOL
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:616-915-4213
Mailing Address - Street 1:7150 KALAMAZOO AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9197
Mailing Address - Country:US
Mailing Address - Phone:616-219-0159
Mailing Address - Fax:616-219-0124
Practice Address - Street 1:7150 KALAMAZOO AVE SE STE C
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9197
Practice Address - Country:US
Practice Address - Phone:616-219-0159
Practice Address - Fax:616-219-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1528479136OtherINDIVIDUAL NPI OF PRESIDENT
MI6301015925OtherLICENSE #