Healthcare Provider Details

I. General information

NPI: 1750969366
Provider Name (Legal Business Name): ALEXANDRA THRASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEX THRASH

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 MCCABE WAY
IRVINE CA
92614-4235
US

IV. Provider business mailing address

2575 MCCABE WAY
IRVINE CA
92614-4235
US

V. Phone/Fax

Practice location:
  • Phone: 714-422-7846
  • Fax:
Mailing address:
  • Phone: 714-422-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number119239
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-161695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: