Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1245864750 |
---|---|
Provider Name | Alexa Nicole Vantrease |
First Address | Lima, OH 45804-1240 |
Second Address | Findlay, OH 45840-3818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2020 |
Last Update Date | 24/02/2020 |