Healthcare Provider Details

I. General information

NPI: 1407217953
Provider Name (Legal Business Name): ALEXANDRA CONCEPCION LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13681 NEWPORT AVE STE 8-329
TUSTIN CA
92780-4689
US

IV. Provider business mailing address

13681 NEWPORT AVE STE 8-329
TUSTIN CA
92780-4689
US

V. Phone/Fax

Practice location:
  • Phone: 714-586-8262
  • Fax:
Mailing address:
  • Phone: 714-586-8262
  • Fax: 714-586-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: