Provider Demographics
NPI:1679045496
Name:MARSON, ALEXIS BRIE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BRIE
Last Name:MARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5249
Mailing Address - Country:US
Mailing Address - Phone:916-677-7187
Mailing Address - Fax:
Practice Address - Street 1:991 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5249
Practice Address - Country:US
Practice Address - Phone:916-677-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80115106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist