Provider Demographics
NPI:1639485378
Name:KRAFT, ALEXANDER (PSYD, MSCP)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KRAFT
Suffix:
Gender:M
Credentials:PSYD, MSCP
Other - Prefix:MR
Other - First Name:ALEXANDER
Other - Middle Name:
Other - Last Name:IMHAEUSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ALEXANDER IMHAEUSER
Mailing Address - Street 1:5001 N PIEDRAS ST
Mailing Address - Street 2:ATTN ANDREA MERCADO / CREDENTIALING
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-4210
Mailing Address - Country:US
Mailing Address - Phone:915-564-6100
Mailing Address - Fax:
Practice Address - Street 1:5001 NORTH PIEDRAS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930
Practice Address - Country:US
Practice Address - Phone:281-536-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM103TP0016X
NMPSY1379103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)