Provider Demographics
NPI:1598167470
Name:ALEXANDER, TRACI YVETTE
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:YVETTE
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 1:2316 ROSTOCK CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2397
Mailing Address - Country:US
Mailing Address - Phone:317-724-2690
Mailing Address - Fax:
Practice Address - Street 1:2316 ROSTOCK CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2397
Practice Address - Country:US
Practice Address - Phone:317-724-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health