Healthcare Provider Details

I. General information

NPI: 1679168686
Provider Name (Legal Business Name): ALEXANDRA EMERY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 N FERDINAND ST
TACOMA WA
98406-3427
US

IV. Provider business mailing address

2107 N FERDINAND ST
TACOMA WA
98406-3427
US

V. Phone/Fax

Practice location:
  • Phone: 360-280-3563
  • Fax:
Mailing address:
  • Phone: 360-280-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number61097006
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: