Provider Demographics
NPI:1235599010
Name:ALEXANDER, MINDY
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N MERIDIAN
Mailing Address - Street 2:SUITE 100 PMB 128
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4409
Mailing Address - Country:US
Mailing Address - Phone:253-270-1950
Mailing Address - Fax:
Practice Address - Street 1:1002 N MERIDIAN
Practice Address - Street 2:SUITE 100 PMB 128
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-4409
Practice Address - Country:US
Practice Address - Phone:253-270-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 390200000X
WALH60843665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program