Provider Demographics
NPI:1508513326
Name:COVER, ALEXANDRA LEA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LEA
Last Name:COVER
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 1:12674 W RIPON ROAD
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366
Mailing Address - Country:US
Mailing Address - Phone:209-273-9797
Mailing Address - Fax:
Practice Address - Street 1:1101 M ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0755
Practice Address - Country:US
Practice Address - Phone:209-737-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist