Provider Demographics
NPI:1861845406
Name:CANDELIER, ALEXIS SHAWN (PSYD)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:SHAWN
Last Name:CANDELIER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 NE 16TH AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3091
Mailing Address - Country:US
Mailing Address - Phone:213-550-5294
Mailing Address - Fax:
Practice Address - Street 1:7700 NE PARKWAY DR STE 215
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6653
Practice Address - Country:US
Practice Address - Phone:213-550-5294
Practice Address - Fax:360-339-5498
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic