Healthcare Provider Details

I. General information

NPI: 1508991100
Provider Name (Legal Business Name): SHANON ANNE ALEXANDER MA,LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NE IRVING ST SUITE 250
PORTLAND OR
97232-2243
US

IV. Provider business mailing address

3113 NW ASHLAND DR
BEAVERTON OR
97006-4664
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-4356
  • Fax:
Mailing address:
  • Phone: 503-531-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0427
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: