Provider Demographics
NPI:1053030775
Name:FARRAJ, ALEXA LAUREN
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:LAUREN
Last Name:FARRAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MESCALITA CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7956
Mailing Address - Country:US
Mailing Address - Phone:951-833-0593
Mailing Address - Fax:
Practice Address - Street 1:221 MESCALITA CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7956
Practice Address - Country:US
Practice Address - Phone:951-833-0593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health