Healthcare Provider Details

I. General information

NPI: 1790472769
Provider Name (Legal Business Name): ALEXANDER ALLISON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S NEBRASKA ST
MARION IN
46953-1874
US

IV. Provider business mailing address

8003 CASTLEWAY DR
INDIANAPOLIS IN
46250-1946
US

V. Phone/Fax

Practice location:
  • Phone: 765-664-7492
  • Fax: 765-400-4466
Mailing address:
  • Phone: 317-576-1335
  • Fax: 317-343-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011273A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: