MEDICARE: ALEXANDRA JOAN NICKLAS

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	AMFT160197	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44AV	OTHER	CA	FS RES MHSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679886832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA JOAN NICKLAS

Provider Business Mailing Address
First Line	:	2115 7TH AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-1663
Country	:	US
Telephone Number	:	831-420-0120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 SHAFFER RD
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5761
Country	:	US
Telephone Number	:	831-427-9343
Fax Number	:

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

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	02/09/2026

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