Provider Demographics
NPI:1902961345
Name:ALEX, PHILIP M (PHD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
Last Name:ALEX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15833 MILL CREEK BLVD., #14187
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082
Mailing Address - Country:US
Mailing Address - Phone:415-457-6234
Mailing Address - Fax:
Practice Address - Street 1:14502 21ST CT SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-5785
Practice Address - Country:US
Practice Address - Phone:415-457-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12556103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist