Provider Demographics
NPI:1639525785
Name:PROMISE, ALEX
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:PROMISE
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 1:124 LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-3301
Mailing Address - Country:US
Mailing Address - Phone:318-538-8345
Mailing Address - Fax:
Practice Address - Street 1:124 LEGACY DR
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3301
Practice Address - Country:US
Practice Address - Phone:318-538-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health