Provider Demographics
NPI:1174134514
Name:PLASCENCIA, ALEXANDRA (AMFT)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:PLASCENCIA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W LOS FELIZ RD UNIT 304
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3559
Mailing Address - Country:US
Mailing Address - Phone:323-573-3981
Mailing Address - Fax:
Practice Address - Street 1:1401 FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-6204
Practice Address - Country:US
Practice Address - Phone:626-252-4941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist