Healthcare Provider Details

I. General information

NPI: 1518432285
Provider Name (Legal Business Name): ALEX WALTERS MA, BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4507 AUCKLAND AVE
TOLUCA LAKE CA
91602-1502
US

IV. Provider business mailing address

4507 AUCKLAND AVE
TOLUCA LAKE CA
91602-1502
US

V. Phone/Fax

Practice location:
  • Phone: 213-437-3460
  • Fax:
Mailing address:
  • Phone: 213-437-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number129855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: