Provider Demographics
NPI:1568155067
Name:ALEXANDER, THOMAS L IV (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:ALEXANDER
Suffix:IV
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 FOREST ST # 476
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2747
Mailing Address - Country:US
Mailing Address - Phone:219-210-0272
Mailing Address - Fax:
Practice Address - Street 1:417 FOREST ST # 476
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2747
Practice Address - Country:US
Practice Address - Phone:219-210-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010797103TC0700X
MI6301019259103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical