Basic Information
| Provider Information | |||||||||
| NPI: | 1750733069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | CHAD | ||||||||
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| Credential: | MA, LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2385 | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497701885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318387837 | ||||||||
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| Practice Location | |||||||||
| Address1: | 314 1/2 HOWARD ST STE 2B | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497704407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318387837 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2016 | ||||||||
| LastUpdateDate: | 04/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401015522 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.