Provider Demographics
NPI:1134659113
Name:TRAXLER, ALEX ROSE (BA, CT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:ROSE
Last Name:TRAXLER
Suffix:
Gender:F
Credentials:BA, CT
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:ROSE
Other - Last Name:SANTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT. 781625
Mailing Address - Street 2:PO BOX 78000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1625
Mailing Address - Country:US
Mailing Address - Phone:614-355-8004
Mailing Address - Fax:614-355-2220
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205
Practice Address - Country:US
Practice Address - Phone:614-722-5793
Practice Address - Fax:614-722-9069
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1800895101YP2500X
OHC1800895101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid