Provider Demographics
NPI:1861535007
Name:FORGNONE-JUDD, ALEXIS SCHELL
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:SCHELL
Last Name:FORGNONE-JUDD
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 1:4143 HAMILTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1704
Mailing Address - Country:US
Mailing Address - Phone:619-363-2708
Mailing Address - Fax:619-566-4436
Practice Address - Street 1:4143 HAMILTON ST APT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1704
Practice Address - Country:US
Practice Address - Phone:619-363-2708
Practice Address - Fax:619-566-4436
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1884Medicare ID - Type UnspecifiedDOCUMENTATION NUMBER