Provider Demographics
NPI:1578117826
Name:PRIMO, ALEX (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:PRIMO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18017 CHATSWORTH ST STE 166
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5608
Mailing Address - Country:US
Mailing Address - Phone:818-875-9017
Mailing Address - Fax:
Practice Address - Street 1:20121 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3408
Practice Address - Country:US
Practice Address - Phone:818-875-9017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111633106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist