Provider Demographics
NPI:1124450358
Name:CRISSEY, ALEXIS MARIE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:CRISSEY
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 1:555 NORTHGATE DR STE 100
Mailing Address - Street 2:FAMILY SERVICE AGENCY OF MARIN
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3696
Mailing Address - Country:US
Mailing Address - Phone:408-313-7682
Mailing Address - Fax:415-491-5750
Practice Address - Street 1:555 NORTHGATE DR STE 100
Practice Address - Street 2:FAMILY SERVICE AGENCY OF MARIN
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3696
Practice Address - Country:US
Practice Address - Phone:408-313-7682
Practice Address - Fax:415-491-5750
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health