Healthcare Provider Details

I. General information

NPI: 1568751402
Provider Name (Legal Business Name): ALEXANDRA MARIE GRAVES MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 COLLIER CORPORATE PKWY
SAINT CHARLES MO
63303-6708
US

IV. Provider business mailing address

2104 COLLIER CORPORATE PKWY
SAINT CHARLES MO
63303-6708
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-9845
  • Fax:
Mailing address:
  • Phone: 314-973-0742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2022027082
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: