Provider Demographics
NPI:1528302734
Name:PECIULIS, ALEXIS ELISENA COSKO (LMFT 106170)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:ELISENA COSKO
Last Name:PECIULIS
Suffix:
Gender:F
Credentials:LMFT 106170
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2927
Mailing Address - Country:US
Mailing Address - Phone:510-300-3170
Mailing Address - Fax:833-516-1896
Practice Address - Street 1:1315 FRUITVALE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2927
Practice Address - Country:US
Practice Address - Phone:510-300-3170
Practice Address - Fax:833-516-1896
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist