Provider Demographics
NPI:1881902161
Name:LARGAESPADA, ALEXANDER A (LMFT)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:A
Last Name:LARGAESPADA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2130
Mailing Address - Country:US
Mailing Address - Phone:209-444-8910
Mailing Address - Fax:209-444-8905
Practice Address - Street 1:445 N SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2026
Practice Address - Country:US
Practice Address - Phone:209-430-3105
Practice Address - Fax:209-444-8905
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125526106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist