Provider Demographics
NPI:1821188681
Name:MARRACH, ALEXA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:
Last Name:MARRACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:MARRACH
Other - Last Name:CARIFFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:7915 FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4124
Mailing Address - Country:US
Mailing Address - Phone:214-417-7945
Mailing Address - Fax:
Practice Address - Street 1:8350 MEADOW RD STE 272
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0334
Practice Address - Country:US
Practice Address - Phone:214-417-7945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25590103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00192CMedicare ID - Type Unspecified
TX0061JCMedicare UPIN
TX7883345Medicare UPIN