Provider Demographics
NPI:1508366774
Name:DODELL, ALYSON (MFT, BCBA)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:DODELL
Suffix:
Gender:F
Credentials:MFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28958 MEDEA MESA RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2745
Mailing Address - Country:US
Mailing Address - Phone:818-398-9132
Mailing Address - Fax:
Practice Address - Street 1:19725 SHERMAN WAY STE 380
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3661
Practice Address - Country:US
Practice Address - Phone:310-247-8712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99267106H00000X
CA12151098103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty