Healthcare Provider Details

I. General information

NPI: 1730806076
Provider Name (Legal Business Name): ALEXANDRIA CLEVERLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 RAWHIDE ST APT 157
LAS VEGAS NV
89122-4805
US

IV. Provider business mailing address

7310 SMOKE RANCH RD STE S
LAS VEGAS NV
89128-0260
US

V. Phone/Fax

Practice location:
  • Phone: 818-267-6016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: