Provider Demographics
NPI:1316074164
Name:ALEXIS, GERALDINE (LIMHP, LPC, LPCC)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:LIMHP, LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S 31ST AVE APT 4710
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1415
Mailing Address - Country:US
Mailing Address - Phone:402-739-3300
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 426
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2988
Practice Address - Country:US
Practice Address - Phone:402-874-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49101YM0800X
AZLPC-5313T101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025257301Medicaid