Provider Demographics
NPI:1538276225
Name:ALEXANDER, KEVIN RYAN (MC, LPC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:RYAN
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 E KESSLER AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4082
Mailing Address - Country:US
Mailing Address - Phone:480-282-1913
Mailing Address - Fax:480-507-8013
Practice Address - Street 1:4115 E VALLEY AUTO DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4606
Practice Address - Country:US
Practice Address - Phone:480-507-7880
Practice Address - Fax:480-507-8013
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional