Provider Demographics
NPI:1346501327
Name:SPROUSE, ALEXANDRA ELIZABETH (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:SPROUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1815 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:1101 MORGAN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3949
Practice Address - Country:US
Practice Address - Phone:870-335-9483
Practice Address - Fax:870-335-9487
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 101YM0800X
ARP1512132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5BX53OtherBCBS
AR192090795Medicaid