Healthcare Provider Details

I. General information

NPI: 1760536692
Provider Name (Legal Business Name): BEVERLY A. ALEXANDER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 FOURTH ST SUITE 2
JONESVILLE LA
71343-2004
US

IV. Provider business mailing address

12398 HIGHWAY 8
JONESVILLE LA
71343-3920
US

V. Phone/Fax

Practice location:
  • Phone: 318-339-8553
  • Fax: 318-339-8554
Mailing address:
  • Phone: 318-339-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1762
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: