Provider Demographics
NPI:1467152165
Name:LAZCANO, ALISON SUE
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:SUE
Last Name:LAZCANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:SUE
Other - Last Name:BRIGNONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6301 BEACH BLVD STE 245
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-4031
Mailing Address - Country:US
Mailing Address - Phone:714-736-0231
Mailing Address - Fax:714-736-0895
Practice Address - Street 1:6301 BEACH BLVD STE 245
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4031
Practice Address - Country:US
Practice Address - Phone:714-736-0231
Practice Address - Fax:714-736-0895
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist