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General NPI Number Information
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NPI Number | 1558911487
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Entity Type | Individual
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Provider Name | ALEXIS GREGORY
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 1800 VINE ST
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City | LOS ANGELES
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State | CA
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Zip | 90028-5250
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Country | US
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Telephone | 310-526-7505
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 SEPULVEDA BLVD APT 202
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City | TORRANCE
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State | CA
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Zip | 90501-3459
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Country | US
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Telephone | 901-921-1126
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11418
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License Number State | CA
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