Basic Information
Provider Information | |||||||||
NPI: | 1457577348 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FOUCHE | ||||||||
FirstName: | ALEXA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.A. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FOUCHE | ||||||||
OtherFirstName: | ALEXA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.A. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 627 NE EVANS ST | ||||||||
Address2: |   | ||||||||
City: | MCMINNVILLE | ||||||||
State: | OR | ||||||||
PostalCode: | 971283923 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7074347523 | ||||||||
FaxNumber: | 5034347523 | ||||||||
Practice Location | |||||||||
Address1: | 627 NE EVANS ST | ||||||||
Address2: |   | ||||||||
City: | MCMINNVILLE | ||||||||
State: | OR | ||||||||
PostalCode: | 971283923 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5034347523 | ||||||||
FaxNumber: | 5034347523 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/18/2007 | ||||||||
LastUpdateDate: | 05/20/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT28314 | CA | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 101YM0800X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.