Provider Demographics
NPI:1932207222
Name:ALEXANDER, DOUGLAS L (MED, LISAC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MED, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 W KIVA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6463
Mailing Address - Country:US
Mailing Address - Phone:602-619-0071
Mailing Address - Fax:
Practice Address - Street 1:5497 W MCCARTNEY RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-7423
Practice Address - Country:US
Practice Address - Phone:520-723-9800
Practice Address - Fax:520-723-3260
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10680101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10680OtherLISAC
AZ105362Medicaid