Healthcare Provider Details

I. General information

NPI: 1457613416
Provider Name (Legal Business Name): ALLEXIS ABDO MS, LMFT, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17609 VENTURA BLVD STE 215
ENCINO CA
91316-5126
US

IV. Provider business mailing address

17156 VOSE ST
LAKE BALBOA CA
91406-3630
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-8352
  • Fax:
Mailing address:
  • Phone: 818-802-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number92616
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: