Provider Demographics
NPI:1689471617
Name:LOCKETT-GLOVER, ALEXIS (MS, LPC-IT, NCC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LOCKETT-GLOVER
Suffix:
Gender:
Credentials:MS, LPC-IT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 N SIDNEY PL APT 204
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3252
Mailing Address - Country:US
Mailing Address - Phone:414-233-4026
Mailing Address - Fax:
Practice Address - Street 1:5555 N PORT WASHINGTON RD STE 300
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4928
Practice Address - Country:US
Practice Address - Phone:414-962-6764
Practice Address - Fax:414-962-6765
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7189-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional