Healthcare Provider Details

I. General information

NPI: 1104186972
Provider Name (Legal Business Name): DR TARA ALEXANDER LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 AUSTIN BLUFFS PKWY STE 3
COLORADO SPRINGS CO
80918-5750
US

IV. Provider business mailing address

3540 AUSTIN BLUFFS PKWY STE 3
COLORADO SPRINGS CO
80918-5750
US

V. Phone/Fax

Practice location:
  • Phone: 719-310-0005
  • Fax: 719-623-0222
Mailing address:
  • Phone: 719-310-0005
  • Fax: 719-623-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number991519
License Number StateCO

VIII. Authorized Official

Name: TARA ALEXANDER
Title or Position: OWNER
Credential: LCSW
Phone: 719-310-0005