Provider Demographics
NPI:1306264924
Name:FARIS, ALEXANDER (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:FARIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E CAMPUS MALL
Mailing Address - Street 2:#7408
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1365
Mailing Address - Country:US
Mailing Address - Phone:608-294-9634
Mailing Address - Fax:
Practice Address - Street 1:333 E CAMPUS MALL
Practice Address - Street 2:#7408
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1365
Practice Address - Country:US
Practice Address - Phone:608-294-9634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2685-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist