1902943939 NPI number — MRS. ALEXANDRA TIQUE-MONTENEGRO LCSW

Table of content: MRS. ALEXANDRA TIQUE-MONTENEGRO LCSW (NPI 1902943939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902943939 NPI number — MRS. ALEXANDRA TIQUE-MONTENEGRO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIQUE-MONTENEGRO
Provider First Name:
ALEXANDRA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TIQUE
Provider Other First Name:
ALEXANDRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902943939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2332 BEVERLY HILLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76114-1756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-625-4254
Provider Business Mailing Address Fax Number:
817-378-0861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 E STATE HIGHWAY 114 FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-824-8775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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