Provider Demographics
NPI:1699262469
Name:TENNYSON, ALEXA JORDAN (LAMFT)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:JORDAN
Last Name:TENNYSON
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 FREMONT AVE S APT 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1124
Mailing Address - Country:US
Mailing Address - Phone:952-237-9130
Mailing Address - Fax:
Practice Address - Street 1:812 E 48TH ST STE 7
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1067
Practice Address - Country:US
Practice Address - Phone:612-293-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist