Provider Demographics
NPI:1861213761
Name:ALEXANDER, KRISTEN (PSYS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WOLF LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46796
Mailing Address - Country:US
Mailing Address - Phone:260-635-2432
Mailing Address - Fax:260-635-2327
Practice Address - Street 1:1283 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOLF LAKE
Practice Address - State:IN
Practice Address - Zip Code:46796
Practice Address - Country:US
Practice Address - Phone:260-635-2432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10247226103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool