Provider Demographics
NPI:1750824561
Name:OTT, ALEXANDER (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:OTT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W AFTON AVE
Mailing Address - Street 2:#101
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1420
Mailing Address - Country:US
Mailing Address - Phone:877-636-9322
Mailing Address - Fax:
Practice Address - Street 1:70 W AFTON AVE
Practice Address - Street 2:#101
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1420
Practice Address - Country:US
Practice Address - Phone:877-636-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000901106H00000X
TX201716106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist