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General NPI Number Information
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NPI Number | 1114391737
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Entity Type | Individual
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Provider Name | ELIZABETH ALEXANDER LPC
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Gender | Female
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 2105 S 54TH ST SUITE 2
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City | ROGERS
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State | AR
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Zip | 72758-8169
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Country | US
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Telephone | 479-268-4557
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 SW 8TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-3559
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Country | US
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Telephone | 479-903-1259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1511422
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | M1511010
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License Number State | AR
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