MEDICARE: MARISSA DANIELLE ALEXANDER-BIRD CP61230883, CG611770

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP61230883	WA
2	101YM0800X	Mental Health Counselor	MC61654601	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558983767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA DANIELLE ALEXANDER-BIRD CP61230883, CG611770

Provider Business Mailing Address
First Line	:	PO BOX 4627
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99220-0627
Country	:	US
Telephone Number	:	509-624-1244
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 W 3RD AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-5809
Country	:	US
Telephone Number	:	509-624-1244
Fax Number	:

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

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	04/24/2025

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