Provider Demographics
NPI:1073990479
Name:DECLEENE, ALEXANDRA (LMFT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:DECLEENE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:DECLEENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-1646
Mailing Address - Country:US
Mailing Address - Phone:424-234-0128
Mailing Address - Fax:
Practice Address - Street 1:141 S TOPANGA CANYON BLVD STE K
Practice Address - Street 2:
Practice Address - City:TOPANGA
Practice Address - State:CA
Practice Address - Zip Code:90290-3146
Practice Address - Country:US
Practice Address - Phone:424-234-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist