MEDICARE: CHAD ALEXANDER MA, LPC

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	101YP2500X	Professional Counselor	6401015522	MI

General Provider Information

NPI Number	:	1750733069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD ALEXANDER MA, LPC

Provider Business Mailing Address
First Line	:	3890 CHARLEVOIX RD STE 304
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8423
Country	:	US
Telephone Number	:	231-838-7837
Fax Number	:

Provider Business Practice Location Address
First Line	:	3890 CHARLEVOIX RD STE 306
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8423
Country	:	US
Telephone Number	:	231-838-7837
Fax Number	:

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	08/27/2024

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