Provider Demographics
NPI:1346672136
Name:WOLF, ALEXIS S (MFT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:S
Last Name:WOLF
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2648
Mailing Address - Country:US
Mailing Address - Phone:415-786-7045
Mailing Address - Fax:
Practice Address - Street 1:325 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2648
Practice Address - Country:US
Practice Address - Phone:415-786-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52872106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist