Provider Demographics
NPI:1821487091
Name:ALEXANDRA DECLEENE
Entity Type:Organization
Organization Name:ALEXANDRA DECLEENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DECLEENE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:424-234-0128
Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-1646
Mailing Address - Country:US
Mailing Address - Phone:424-234-0128
Mailing Address - Fax:
Practice Address - Street 1:22653 PCH #10
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265
Practice Address - Country:US
Practice Address - Phone:424-234-0128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty