Healthcare Provider Details

I. General information

NPI: 1356562177
Provider Name (Legal Business Name): CLYDE ALEXANDER PH.D, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43996 WOODWARD AVENUE SUITE 102
BLOOMFIELD HILLS MI
48302
US

IV. Provider business mailing address

4787 SHORELINE BLVD.
WATERFORD MI
48329
US

V. Phone/Fax

Practice location:
  • Phone: 248-335-1711
  • Fax: 248-335-7950
Mailing address:
  • Phone: 248-499-3655
  • Fax: 248-383-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801059815
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801059815
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6801059815
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6801059815
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: