Provider Demographics
NPI:1194458885
Name:VAN CLEAVE, ALEXANDRA BAILEY
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:BAILEY
Last Name:VAN CLEAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SANDRA MURAIDA WAY APT 623
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4845
Mailing Address - Country:US
Mailing Address - Phone:469-865-4277
Mailing Address - Fax:
Practice Address - Street 1:115 SANDRA MURAIDA WAY APT 623
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4845
Practice Address - Country:US
Practice Address - Phone:469-865-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health