Provider Demographics
NPI:1063088185
Name:MAYER, ALEXANDER (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:MAYER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 S 900 E UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1932
Mailing Address - Country:US
Mailing Address - Phone:510-910-9675
Mailing Address - Fax:
Practice Address - Street 1:1733 SKILLMAN LN
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-1250
Practice Address - Country:US
Practice Address - Phone:510-910-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-30
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1131040-3501101YM0800X
CA103339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty