MEDICARE: ALEXA GOLDING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	109637	CA

General Provider Information

NPI Number	:	1477112530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA GOLDING

Provider Business Mailing Address
First Line	:	11836 DARLINGTON AVE APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5417
Country	:	US
Telephone Number	:	248-982-6359
Fax Number	:

Provider Business Practice Location Address
First Line	:	12100 WILSHIRE BLVD FL 8
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7120
Country	:	US
Telephone Number	:	556-831-0896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	06/08/2021

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