MEDICARE: ALEXANDRA MCAUSLAN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	15205	AZ

General Provider Information

NPI Number	:	1558831362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA MCAUSLAN LMFT

Provider Business Mailing Address
First Line	:	8125 E CLARENDON AVE
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-5805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2563 S VAL VISTA DR STE 108
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-6231
Country	:	US
Telephone Number	:	703-362-8601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	12/05/2018

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