Provider Demographics
NPI:1083754089
Name:PRICE, ALAN D (PHD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:D
Last Name:PRICE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 N OXNARD BLVD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-5480
Mailing Address - Country:US
Mailing Address - Phone:808-351-1639
Mailing Address - Fax:
Practice Address - Street 1:30423 CANWOOD ST STE 138
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4315
Practice Address - Country:US
Practice Address - Phone:818-707-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28367103TC0700X
HIPSY 454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical