Provider Demographics
NPI:1104378470
Name:VAN EPEREN, ALEXIS (MA, NBCC, LPC, ICS)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:VAN EPEREN
Suffix:
Gender:F
Credentials:MA, NBCC, LPC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4506
Mailing Address - Country:US
Mailing Address - Phone:920-573-6089
Mailing Address - Fax:
Practice Address - Street 1:1835 E EDGEWOOD DR STE 105107
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-9407
Practice Address - Country:US
Practice Address - Phone:920-573-6089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional