Healthcare Provider Details

I. General information

NPI: 1174395404
Provider Name (Legal Business Name): CHRISTOPHER HENRY ALAN PRAETZEL PSYD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCLA CAPS JOHN WOODEN CENTER WEST 221 WESTWOOD PLAZA
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

1617 GLENDON AVE APT 3
LOS ANGELES CA
90024-5734
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0768
  • Fax:
Mailing address:
  • Phone: 609-202-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number35190
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: