Provider Demographics
NPI:1518308568
Name:PRESCOTT, ALEXIS ANNE (MFT INTERM)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANNE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:MFT INTERM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11712 MOORPARK ST STE 211
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2164
Mailing Address - Country:US
Mailing Address - Phone:818-512-0685
Mailing Address - Fax:
Practice Address - Street 1:11712 MOORPARK ST STE 211
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604
Practice Address - Country:US
Practice Address - Phone:818-512-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT10358101YM0800X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health