Provider Demographics
NPI:1568575702
Name:DE VERE, ALEXANDRA (LMHC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:DE VERE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 BRANDON DR SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8801
Mailing Address - Country:US
Mailing Address - Phone:505-565-1619
Mailing Address - Fax:505-867-2383
Practice Address - Street 1:872 S CAMINO DEL PUEBLO
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5927
Practice Address - Country:US
Practice Address - Phone:505-867-2383
Practice Address - Fax:505-867-7293
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMHC: 0088721101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor