Healthcare Provider Details

I. General information

NPI: 1043131675
Provider Name (Legal Business Name): KLARISSA ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 CHURCHLAND AVE
DAYTON OH
45406-1203
US

IV. Provider business mailing address

5115 WELL FLEET DR
TROTWOOD OH
45426-1419
US

V. Phone/Fax

Practice location:
  • Phone: 937-813-7133
  • Fax:
Mailing address:
  • Phone: 916-579-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: