Provider Demographics
NPI:1609270305
Name:ALEXANDER J. MUZICHUK
Entity Type:Organization
Organization Name:ALEXANDER J. MUZICHUK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUZICHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-887-4676
Mailing Address - Street 1:1203 E MELTON RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6384
Mailing Address - Country:US
Mailing Address - Phone:904-887-4676
Mailing Address - Fax:417-725-6206
Practice Address - Street 1:380 E STATE HIGHWAY CC
Practice Address - Street 2:SUITE A101
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7459
Practice Address - Country:US
Practice Address - Phone:417-725-8810
Practice Address - Fax:417-725-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty