Provider Demographics
NPI:1043478563
Name:ALCALA, ANNA B (MS, LMFT#84636)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:B
Last Name:ALCALA
Suffix:
Gender:F
Credentials:MS, LMFT#84636
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GRANADA ST STE E
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7725
Mailing Address - Country:US
Mailing Address - Phone:805-628-2204
Mailing Address - Fax:
Practice Address - Street 1:155 GRANADA ST STE I
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7725
Practice Address - Country:US
Practice Address - Phone:805-628-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT#84636106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist