Healthcare Provider Details

I. General information

NPI: 1023426020
Provider Name (Legal Business Name): ALEX GREGORY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 6TH AVE S
SAINT CLOUD MN
56301-5209
US

IV. Provider business mailing address

PO BOX 9859
FARGO ND
58106-9859
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-5930
  • Fax: 651-925-0057
Mailing address:
  • Phone: 701-451-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2860
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: