Provider Demographics
NPI:1588919104
Name:EHRSAM, ALEX GEORGE (MS)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:GEORGE
Last Name:EHRSAM
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 MARTY ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3737
Mailing Address - Country:US
Mailing Address - Phone:913-262-8773
Mailing Address - Fax:913-385-9856
Practice Address - Street 1:8100 MARTY ST
Practice Address - Street 2:SUITE 107
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3737
Practice Address - Country:US
Practice Address - Phone:913-262-8773
Practice Address - Fax:913-385-9856
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist