Provider Demographics
NPI:1710643937
Name:HART, ALEXA (LMHC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LMHC, ATR-BC
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5707 N PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2536
Mailing Address - Country:US
Mailing Address - Phone:317-426-1549
Mailing Address - Fax:
Practice Address - Street 1:5707 N PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2536
Practice Address - Country:US
Practice Address - Phone:317-426-1549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003276A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health