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General NPI Number Information
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NPI Number | 1629655444
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Entity Type | Individual
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Provider Name | ALEXIS WILSON
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Gender | Female
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 06/21/2025
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Provider Practice Location Address
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Address Line | 1211 MARICOPA HWY STE 265
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City | OJAI
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State | CA
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Zip | 93023-3161
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Country | US
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Telephone | 805-798-3150
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Fax | 805-232-3224
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Provider Business Mailing Address
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Address Line | PO BOX 4590 11043 CITRUS DR
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City | VENTURA
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State | CA
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Zip | 93004-1300
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Country | US
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Telephone | 820-203-7614
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 143568
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License Number State | CA
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