Healthcare Provider Details

I. General information

NPI: 1568221216
Provider Name (Legal Business Name): ALEJANDRO ZAVALA PSYD, LMFT, CADCII
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E GLENOAKS BLVD STE 3
GLENDALE CA
91207-2118
US

IV. Provider business mailing address

PO BOX 39473
LOS ANGELES CA
90039-0473
US

V. Phone/Fax

Practice location:
  • Phone: 323-570-2899
  • Fax:
Mailing address:
  • Phone: 323-570-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII30830219
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT124981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: