Provider Demographics
NPI:1508669110
Name:VANSICKLE, ALEXA (MA, LPCC)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:VANSICKLE
Suffix:
Gender:
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 VINTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3728
Mailing Address - Country:US
Mailing Address - Phone:507-227-6138
Mailing Address - Fax:
Practice Address - Street 1:9352 OAK AVE
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-9422
Practice Address - Country:US
Practice Address - Phone:952-955-4714
Practice Address - Fax:952-955-6213
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19278101YP2500X
MN2309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional