Provider Demographics
NPI:1245098607
Name:NANKERVIS, ALEXXIS (AMFT)
Entity type:Individual
Prefix:
First Name:ALEXXIS
Middle Name:
Last Name:NANKERVIS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N ROSE DR # 388
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7513
Mailing Address - Country:US
Mailing Address - Phone:714-512-1876
Mailing Address - Fax:
Practice Address - Street 1:3020 OLD RANCH PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2751
Practice Address - Country:US
Practice Address - Phone:714-512-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144915106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist