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General NPI Number Information
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NPI Number | 1487381638
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Entity Type | Individual
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Provider Name | ALEXANDER EVAN HARRIS LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 2255 MIDPOINT DR
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City | FORT COLLINS
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State | CO
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Zip | 80525-4306
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Country | US
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Telephone | 970-498-7541
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Fax |
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Provider Business Mailing Address
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Address Line | 1928 OAKWOOD DR
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City | FORT COLLINS
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State | CO
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Zip | 80521-4344
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Country | US
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Telephone | 585-975-9701
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.0992833
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License Number State | CO
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