Provider Demographics
NPI:1861783052
Name:MITCHELL, ALEXIS LAUREN (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LAUREN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:LAUREN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 E GILBERT ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0936
Mailing Address - Country:US
Mailing Address - Phone:909-387-7406
Mailing Address - Fax:
Practice Address - Street 1:900 E GILBERT ST STE 4
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0936
Practice Address - Country:US
Practice Address - Phone:909-387-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA908491041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program