Healthcare Provider Details

I. General information

NPI: 1336528041
Provider Name (Legal Business Name): LEXINGTON JEAN MIX MA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEXINGTON MAGNUSON MA, MFT

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17402 CHATSWORTH ST STE 104
GRANADA HILLS CA
91344-7618
US

IV. Provider business mailing address

17402 CHATSWORTH ST STE 104
GRANADA HILLS CA
91344-7618
US

V. Phone/Fax

Practice location:
  • Phone: 818-402-5639
  • Fax: 818-936-0960
Mailing address:
  • Phone: 818-402-5639
  • Fax: 818-936-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number101710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: