Provider Demographics
NPI:1902677560
Name:ALEX, AZURE D (MFT STATE INTERN)
Entity Type:Individual
Prefix:
First Name:AZURE
Middle Name:D
Last Name:ALEX
Suffix:
Gender:F
Credentials:MFT STATE INTERN
Other - Prefix:
Other - First Name:AZURE
Other - Middle Name:D
Other - Last Name:MCMILLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 N TENAYA WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0480
Mailing Address - Country:US
Mailing Address - Phone:702-757-8720
Mailing Address - Fax:702-974-4677
Practice Address - Street 1:2701 N TENAYA WAY STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0480
Practice Address - Country:US
Practice Address - Phone:702-757-8720
Practice Address - Fax:702-974-4677
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVM14327101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor