Provider Demographics
NPI:1174395404
Name:PRAETZEL, CHRISTOPHER HENRY ALAN (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:HENRY ALAN
Last Name:PRAETZEL
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 GLENDON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5734
Mailing Address - Country:US
Mailing Address - Phone:609-202-7123
Mailing Address - Fax:
Practice Address - Street 1:UCLA CAPS JOHN WOODEN CENTER WEST 221 WESTWOOD PLAZA
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY796103TC1900X
103TE1100X
CA35190103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports