Provider Demographics
NPI:1295385995
Name:REAL, ADRIAN ALEX (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ALEX
Last Name:REAL
Suffix:
Gender:M
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9003 RESEDA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6513
Mailing Address - Country:US
Mailing Address - Phone:310-756-3370
Mailing Address - Fax:
Practice Address - Street 1:9003 RESEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6513
Practice Address - Country:US
Practice Address - Phone:310-756-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health