Provider Demographics
NPI:1871102467
Name:TANYA ALEXANDER
Entity type:Organization
Organization Name:TANYA ALEXANDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:817-825-3530
Mailing Address - Street 1:603 S MAIN ST STE 208
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5390
Mailing Address - Country:US
Mailing Address - Phone:817-825-3530
Mailing Address - Fax:
Practice Address - Street 1:603 S MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5390
Practice Address - Country:US
Practice Address - Phone:817-825-3530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203484OtherLICENSED MARRIAGE AND FAMILY THERAPIST