Provider Demographics
NPI:1417373655
Name:ALEXANDER, STEPHEN
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N 400 E
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-3305
Mailing Address - Country:US
Mailing Address - Phone:435-750-3187
Mailing Address - Fax:435-750-3046
Practice Address - Street 1:440 N 400 E
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-3305
Practice Address - Country:US
Practice Address - Phone:435-750-3187
Practice Address - Fax:435-750-3046
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT315705-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health