Healthcare Provider Details

I. General information

NPI: 1871261008
Provider Name (Legal Business Name): ALEX PEUSER MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 N MILWAUKEE AVE
CHICAGO IL
60618-6612
US

IV. Provider business mailing address

3171 N HUDSON AVE APT 2B
CHICAGO IL
60657-7222
US

V. Phone/Fax

Practice location:
  • Phone: 872-588-6011
  • Fax:
Mailing address:
  • Phone: 913-972-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number144.000157
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: