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General NPI Number Information
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NPI Number | 1376187237
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Entity Type | Individual
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Provider Name | ALEX MAURER LSW, LADC
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Gender | Male
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 109 WASHBURNE AVE
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City | PAYNESVILLE
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State | MN
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Zip | 56362-1640
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Country | US
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Telephone | 320-243-1599
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Fax | 320-243-1570
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Provider Business Mailing Address
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Address Line | 125 W 6TH ST
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City | LITCHFIELD
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State | MN
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Zip | 55355-1706
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 305581
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License Number State | MN
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