Provider Demographics
NPI:1992170344
Name:ALVAREZ, ALEX G SR (BA/LISAC)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:G
Last Name:ALVAREZ
Suffix:SR
Gender:M
Credentials:BA/LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 S PITAYA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-8918
Mailing Address - Country:US
Mailing Address - Phone:520-879-5691
Mailing Address - Fax:520-879-6099
Practice Address - Street 1:7490 S CAMINO DE OESTE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-9308
Practice Address - Country:US
Practice Address - Phone:520-879-5691
Practice Address - Fax:520-879-6099
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11459101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)