Provider Demographics
NPI:1982614335
Name:BARENDS, ALEX WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:WILLIAM
Last Name:BARENDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E WASHINGTON ST
Mailing Address - Street 2:SUITE 106W
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2024
Mailing Address - Country:US
Mailing Address - Phone:734-665-1138
Mailing Address - Fax:
Practice Address - Street 1:425 E WASHINGTON ST
Practice Address - Street 2:SUITE 106W
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2024
Practice Address - Country:US
Practice Address - Phone:734-665-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM 23130Medicare PIN