Provider Demographics
NPI:1952410615
Name:RABOURN, ALEXIS MARIE (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:MARIE
Last Name:RABOURN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 W TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6066
Mailing Address - Country:US
Mailing Address - Phone:707-208-6325
Mailing Address - Fax:707-374-5952
Practice Address - Street 1:1652 W TEXAS ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6066
Practice Address - Country:US
Practice Address - Phone:707-425-5008
Practice Address - Fax:707-374-5952
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist