Provider Demographics
NPI:1225199664
Name:SELWOOD, ALEXIS F (LCSW,MSW,PHD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:F
Last Name:SELWOOD
Suffix:
Gender:F
Credentials:LCSW,MSW,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 MORNINGSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3515
Mailing Address - Country:US
Mailing Address - Phone:323-469-8462
Mailing Address - Fax:
Practice Address - Street 1:829 MORNINGSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:323-469-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS99381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical