Provider Demographics
NPI:1194467803
Name:LACHINO, ALEXIS TEALE (LISW)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:TEALE
Last Name:LACHINO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:GILBERTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50634-0635
Mailing Address - Country:US
Mailing Address - Phone:319-404-1707
Mailing Address - Fax:
Practice Address - Street 1:3261 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-2051
Practice Address - Country:US
Practice Address - Phone:319-239-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA104994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health