Provider Demographics
NPI:1649827171
Name:ALEXANDER, DAVARRES (QMHP)
Entity type:Individual
Prefix:
First Name:DAVARRES
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9913 SHELBYVILLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2902
Mailing Address - Country:US
Mailing Address - Phone:980-777-0586
Mailing Address - Fax:
Practice Address - Street 1:9913 SHELBYVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2902
Practice Address - Country:US
Practice Address - Phone:980-777-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist