Provider Demographics
NPI:1013204353
Name:TAYLOR, ALEXANDRA CHRISTINE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:CHRISTINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:ALEXANDRA
Other - Middle Name:CHRISTINE
Other - Last Name:ACHESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31874 CALLE BALLENTINE
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6708
Mailing Address - Country:US
Mailing Address - Phone:951-821-8609
Mailing Address - Fax:951-501-3535
Practice Address - Street 1:43385 BUSINESS PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3692
Practice Address - Country:US
Practice Address - Phone:951-821-8609
Practice Address - Fax:951-501-3535
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110411106H00000X
CAPCI 112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110411OtherMARRIAGE AND FAMILY THERAPIST LICENSE