Healthcare Provider Details

I. General information

NPI: 1124113600
Provider Name (Legal Business Name): JOE B ALEXANDER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4384 SANDALWOOD DR
LAS CRUCES NM
88011
US

IV. Provider business mailing address

4384 SANDALWOOD DR
LAS CRUCES NM
88011
US

V. Phone/Fax

Practice location:
  • Phone: 505-496-4914
  • Fax: 505-521-4692
Mailing address:
  • Phone: 505-496-4914
  • Fax: 505-521-4692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number98
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: