Provider Demographics
NPI:1124284567
Name:KEVONIAN, ALEXIA
Entity type:Individual
Prefix:
First Name:ALEXIA
Middle Name:
Last Name:KEVONIAN
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 1:20121 VENTURA BLVD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2546
Mailing Address - Country:US
Mailing Address - Phone:800-990-9179
Mailing Address - Fax:
Practice Address - Street 1:20121 VENTURA BLVD
Practice Address - Street 2:SUITE 314
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2546
Practice Address - Country:US
Practice Address - Phone:800-990-9179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20178103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical