Healthcare Provider Details

I. General information

NPI: 1528259868
Provider Name (Legal Business Name): ALEXIS VICTORIA ARCZYNSKI M.S., MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S GLENDORA AVE
WEST COVINA CA
91790-4923
US

IV. Provider business mailing address

1107 S GLENDORA AVE
WEST COVINA CA
91790-4923
US

V. Phone/Fax

Practice location:
  • Phone: 626-814-9085
  • Fax: 626-960-9125
Mailing address:
  • Phone: 626-814-9085
  • Fax: 626-960-9125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF 53135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: