Provider Demographics
NPI:1154761799
Name:BUNCH, ALEX JOHNNIE (LMFT)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:JOHNNIE
Last Name:BUNCH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23147 VENTURA BLVD
Mailing Address - Street 2:250
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-0710
Mailing Address - Country:US
Mailing Address - Phone:818-987-7707
Mailing Address - Fax:
Practice Address - Street 1:23147 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1112
Practice Address - Country:US
Practice Address - Phone:818-987-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC93392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7184OtherMEDI-CAL
CA7667OtherMEDI-CAL
CA7368OtherMEDI-CAL
CA7708OtherMEDI-CAL