Provider Demographics
NPI:1083232656
Name:VIS, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:VIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 LAWNDALE CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6188
Mailing Address - Country:US
Mailing Address - Phone:605-321-4303
Mailing Address - Fax:
Practice Address - Street 1:1964 HOWELL BRANCH RD STE 106
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1042
Practice Address - Country:US
Practice Address - Phone:407-906-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health