Provider Demographics
NPI:1710738331
Name:ALEXANDER, BERTHA JANE
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:JANE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:WILTZ
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:153 LUCY DR
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2436
Mailing Address - Country:US
Mailing Address - Phone:615-973-9361
Mailing Address - Fax:
Practice Address - Street 1:537 BLYTHE AVE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2223
Practice Address - Country:US
Practice Address - Phone:615-327-3060
Practice Address - Fax:615-206-8004
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health