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General NPI Number Information
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NPI Number | 1942438718
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Entity Type | Organization
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Legal Business Name | JOHN ALEXANDER ISRAEL CONSULTING INC
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1401 S WOODLAND AVE STE 3
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-7189
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Country | US
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Telephone | 219-877-4758
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2257
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City | CHESTERTON
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State | IN
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Zip | 46304-0357
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Country | US
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Telephone | 219-926-8320
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Fax | 219-926-3524
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | TRACY L FREEZE
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Credential |
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Telephone | 219-926-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20042094A
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License Number State | IN
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