Provider Demographics
NPI:1689078396
Name:MUZICHUK, ALEXANDER JOHN (PLPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOHN
Last Name:MUZICHUK
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E STATE HIGHWAY CC
Mailing Address - Street 2:SUITE A101
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7459
Mailing Address - Country:US
Mailing Address - Phone:417-725-8810
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
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014040806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional