Provider Demographics
NPI:1154048163
Name:BONSELL, ALEXIS MARISSA (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARISSA
Last Name:BONSELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6797
Mailing Address - Country:US
Mailing Address - Phone:904-868-0040
Mailing Address - Fax:
Practice Address - Street 1:8800 S 1ST ST APT 931
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-0010
Practice Address - Country:US
Practice Address - Phone:904-868-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical