MEDICARE: ALEXANDRA DIANE HOLDOM AMFT157044. CA.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	106H00000X	Marriage & Family Therapist
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518597467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA DIANE HOLDOM AMFT157044. CA.

Provider Business Mailing Address
First Line	:	PO BOX 2452
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93457-2452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 ORCUTT RD STE 206
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-2618
Country	:	US
Telephone Number	:	820-946-4822
Fax Number	:

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

Provider Enumeration Date	:	01/20/2020
Last Update Date	:	03/17/2026

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Directions to “ ALEXANDRA DIANE HOLDOM AMFT157044. CA.” Practice Location

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