MEDICARE: CHARLOTTE HALE ALEXANDER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker	856	WY

General Provider Information

NPI Number	:	1265673388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE HALE ALEXANDER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 11986
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-1986
Country	:	US
Telephone Number	:	908-872-7594
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 S CACHE ST # 15
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8222
Country	:	US
Telephone Number	:	307-732-6670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/27/2015

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