Provider Demographics
NPI:1275015489
Name:CHERNYSHOV, ALEXANDER
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:CHERNYSHOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13711 WALLISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-3908
Mailing Address - Country:US
Mailing Address - Phone:713-455-7777
Mailing Address - Fax:713-453-7337
Practice Address - Street 1:13711 WALLISVILLE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049
Practice Address - Country:US
Practice Address - Phone:713-455-7777
Practice Address - Fax:713-453-7337
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional