Provider Demographics
NPI:1508591231
Name:ALEXANDER, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
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 1:10858 RUSSELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42274-9765
Mailing Address - Country:US
Mailing Address - Phone:270-784-4943
Mailing Address - Fax:
Practice Address - Street 1:263 HUNTSVILLE QUALITY RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-7395
Practice Address - Country:US
Practice Address - Phone:270-934-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA