Provider Demographics
NPI:1578226213
Name:BARRAGAN, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BARRAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14930 VENTURA BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3487
Mailing Address - Country:US
Mailing Address - Phone:323-790-6004
Mailing Address - Fax:
Practice Address - Street 1:14930 VENTURA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3487
Practice Address - Country:US
Practice Address - Phone:323-790-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPC10254101YP2500X
CAAMFT127891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional