=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073078754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN ALEXANDER LCPC, PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2019
-----------------------------------------------------
Last Update Date | 02/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8433 SOUTHSIDE BLVD APT 911
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-8473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-465-0398
-----------------------------------------------------
Fax | 786-257-5650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8433 SOUTHSIDE BLVD APT 911
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-8473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-465-0398
-----------------------------------------------------
Fax | 786-257-5650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number | AL74086
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------