Healthcare Provider Details

I. General information

NPI: 1477324374
Provider Name (Legal Business Name): ALEXA ENYART AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 N MCCADDEN PL UNIT 3425
LOS ANGELES CA
90028
US

IV. Provider business mailing address

3010 WILSHIRE BLVD # 354
LOS ANGELES CA
90010-1103
US

V. Phone/Fax

Practice location:
  • Phone: 949-620-1959
  • Fax:
Mailing address:
  • Phone: 949-620-1959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT141288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: