Provider Demographics
NPI:1558699306
Name:MACTERNAN, ALYX RAIN (EDD)
Entity Type:Individual
Prefix:DR
First Name:ALYX
Middle Name:RAIN
Last Name:MACTERNAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5574 BLACK AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5802
Mailing Address - Country:US
Mailing Address - Phone:925-596-4769
Mailing Address - Fax:
Practice Address - Street 1:7219 HALTON CT
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6304
Practice Address - Country:US
Practice Address - Phone:407-347-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GA008598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional