Provider Demographics
NPI:1922431444
Name:STICKLER, ALEXANDER HAN (MFTI)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:HAN
Last Name:STICKLER
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 BUENA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-2014
Mailing Address - Country:US
Mailing Address - Phone:323-428-0206
Mailing Address - Fax:
Practice Address - Street 1:29 6TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3507
Practice Address - Country:US
Practice Address - Phone:323-428-0206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
CAIMF75946390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist