MEDICARE: MS. ALEXIS MARIE RABOURN M.A., M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC15570	CA

General Provider Information

NPI Number	:	1952410615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXIS MARIE RABOURN M.A., M.F.T.

Provider Business Mailing Address
First Line	:	1652 W TEXAS ST
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6066
Country	:	US
Telephone Number	:	707-208-6325
Fax Number	:	707-374-5952

Provider Business Practice Location Address
First Line	:	1652 W TEXAS ST
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6066
Country	:	US
Telephone Number	:	707-425-5008
Fax Number	:	707-374-5952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/31/2020

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