Provider Demographics
NPI:1457900128
Name:BAER, ALEXIS NIKOL
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NIKOL
Last Name:BAER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GRISWOLD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2687
Mailing Address - Country:US
Mailing Address - Phone:734-325-8685
Mailing Address - Fax:
Practice Address - Street 1:670 GRISWOLD ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2687
Practice Address - Country:US
Practice Address - Phone:734-325-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361008205101YP2500X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional