1457218414 NPI number — MRS. ALEXIS YVONNE HARRISON LCDC

Table of content: MRS. ALEXIS YVONNE HARRISON LCDC (NPI 1457218414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457218414 NPI number — MRS. ALEXIS YVONNE HARRISON LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
ALEXIS
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457218414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2710 JOSEPH DR
Provider Second Line Business Mailing Address:
2220 AUSTIN AVE, WACO, TEXAS 76701
Provider Business Mailing Address City Name:
COPPERAS COVE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76522-7582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-297-8999
Provider Business Mailing Address Fax Number:
254-867-6533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2220 AUSTIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76701-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-297-8999
Provider Business Practice Location Address Fax Number:
254-867-6533
Provider Enumeration Date:
01/09/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  17632 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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