Provider Demographics
NPI:1831135144
Name:ALEXANDER, TARA L (LCSW)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:L
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26386
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80936-6386
Mailing Address - Country:US
Mailing Address - Phone:719-638-8844
Mailing Address - Fax:719-623-0222
Practice Address - Street 1:4740 FLINTRIDGE DR STE 220H
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4273
Practice Address - Country:US
Practice Address - Phone:719-310-0005
Practice Address - Fax:719-623-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9915191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA0849Medicare UPIN