Provider Demographics
NPI:1144820598
Name:KRIEG, ALEXANDER WILLIAM (PHD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:WILLIAM
Last Name:KRIEG
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 1:31235 RAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1367
Mailing Address - Country:US
Mailing Address - Phone:248-383-5532
Mailing Address - Fax:
Practice Address - Street 1:31235 RAMBLE RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1367
Practice Address - Country:US
Practice Address - Phone:248-383-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018924103T00000X, 103TB0200X, 103TC0700X, 103TC0700X
MI6351004125103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral