Provider Demographics
NPI:1972013746
Name:PERRY, ALEXANDRIA ELIZABETH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:ELIZABETH
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7281 DUMOSA AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3781
Mailing Address - Country:US
Mailing Address - Phone:804-658-7733
Mailing Address - Fax:
Practice Address - Street 1:7281 DUMOSA AVE STE 4
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3781
Practice Address - Country:US
Practice Address - Phone:760-853-4755
Practice Address - Fax:760-513-9717
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6463101YP2500X
171M00000X
CA128015106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty