Provider Demographics
NPI:1457577348
Name:FOUCHE, ALEXA (MA)
Entity Type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:
Last Name:FOUCHE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:FOUCHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:627 NE EVANS ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3923
Mailing Address - Country:US
Mailing Address - Phone:707-434-7523
Mailing Address - Fax:503-434-7523
Practice Address - Street 1:627 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3923
Practice Address - Country:US
Practice Address - Phone:503-434-7523
Practice Address - Fax:503-434-7523
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28314106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist