Provider Demographics
NPI:1619239720
Name:ALEXANDER, WILLIS ULYSSES JR
Entity Type:Individual
Prefix:
First Name:WILLIS
Middle Name:ULYSSES
Last Name:ALEXANDER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-2406
Mailing Address - Country:US
Mailing Address - Phone:405-659-6405
Mailing Address - Fax:
Practice Address - Street 1:5929 N MAY AVE STE 218
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3925
Practice Address - Country:US
Practice Address - Phone:405-254-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health