Provider Demographics
NPI:1033585690
Name:WILDER, ALEXANDRA (LMFTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 N ORACLE RD APT 13203
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-5131
Mailing Address - Country:US
Mailing Address - Phone:360-739-4641
Mailing Address - Fax:
Practice Address - Street 1:10005 24TH ST E
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98371-2130
Practice Address - Country:US
Practice Address - Phone:253-533-3248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WAMG61467071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)