Provider Demographics
NPI:1124889787
Name:RACE, ALEXANDER GREGORY-LANTAFF (LMFTA)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:GREGORY-LANTAFF
Last Name:RACE
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9757 NE JUANITA DR STE 206
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4299
Mailing Address - Country:US
Mailing Address - Phone:425-242-6267
Mailing Address - Fax:
Practice Address - Street 1:9757 NE JUANITA DR STE 206
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4299
Practice Address - Country:US
Practice Address - Phone:425-242-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61497498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist