Provider Demographics
NPI:1316352958
Name:ORNELLAS, ALEXIS MITSUKO KAMAKANOE (LPC, LAC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MITSUKO KAMAKANOE
Last Name:ORNELLAS
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 MAPLETON AVE LOT 24
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3828
Mailing Address - Country:US
Mailing Address - Phone:720-408-5393
Mailing Address - Fax:
Practice Address - Street 1:2635 MAPLETON AVE LOT 24
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3828
Practice Address - Country:US
Practice Address - Phone:720-408-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000422101YA0400X
COLPC.0012209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)