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Provider Information for 1639816465


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ALEXIA NEWBERN LCPC


Sex: Female

NPI: 1639816465
Last Updated: 2023-08-03
Certification Date: 2023-05-09

Details

NameValue
NPI1639816465
Enumeration Date2022-05-13
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 118 WILSON ST
PARK FOREST, IL 60466-1365
United States

Phone: | Fax:
 
Primary Practice Address 118 WILSON ST
PARK FOREST, IL 60466-1365
United States

Phone: 630-276-8872 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101Y00000X - Counselor IL178016312
Yes 101YP2500X - Counselor - ProfessionalIL180015099