Provider Demographics
NPI:1821481342
Name:ALEXANDER, ERIQUE ASHANT'E
Entity Type:Individual
Prefix:
First Name:ERIQUE
Middle Name:ASHANT'E
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 BROADWAY EXT STE 180
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-8246
Mailing Address - Country:US
Mailing Address - Phone:405-607-4041
Mailing Address - Fax:405-463-0090
Practice Address - Street 1:6501 BROADWAY EXT STE 180
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8246
Practice Address - Country:US
Practice Address - Phone:405-607-4041
Practice Address - Fax:405-463-0090
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health