Provider Demographics
NPI:1447873088
Name:ALEX, NICOLLE (MFT)
Entity type:Individual
Prefix:MS
First Name:NICOLLE
Middle Name:
Last Name:ALEX
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:NICOLLE
Other - Middle Name:ALEXANDRIA
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NICOLLE SANCHEZ
Mailing Address - Street 1:1228 ANCHORS WAY UNIT 201
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4336
Mailing Address - Country:US
Mailing Address - Phone:310-922-2072
Mailing Address - Fax:
Practice Address - Street 1:28310 ROADSIDE DR STE 203
Practice Address - Street 2:
Practice Address - City:AGOURA
Practice Address - State:CA
Practice Address - Zip Code:91301-4958
Practice Address - Country:US
Practice Address - Phone:805-931-6163
Practice Address - Fax:855-808-0752
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA863950337OtherIRS