Provider Demographics
NPI:1235288275
Name:WEXLER, BRUCE ALLAN (MFT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALLAN
Last Name:WEXLER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15597 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5241
Mailing Address - Country:US
Mailing Address - Phone:858-679-5007
Mailing Address - Fax:
Practice Address - Street 1:10025 LOS RANCHITOS RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-2723
Practice Address - Country:US
Practice Address - Phone:619-258-4012
Practice Address - Fax:619-258-4011
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23778106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist