Individual
ALEXANDRA JOAN NICKLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 SHAFFER RD, SANTA CRUZ, CA 95060-5761
(831) 427-9343
Mailing address
2115 7TH AVE, SANTA CRUZ, CA 95062-1663
(831) 420-0120
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
AMFT160197
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44AV
FS RES MHSS
CA
05
—
MEDI-CAL PRV NBR
—
CA
Enumeration date
07/16/2010
Last updated
02/09/2026
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