| Doctor Name: | DR. SUSAN MARIA AXTELL |
| NPI Number: | 1922323104 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | PSY20123 |
| Business Practice Address: | 1500 San Pablo St 4th Floor Los Angeles, CA - 900335313 |
| Business Phone Number: | 3234427400 |
| Business Fax Number: | |
| Mailing Address: | Po Box 31309, LOS ANGELES |
| State: | CA |
| Postal Code: | 900310309 |
| Phone Number: | 3234427400 |
| Fax Number: | |
| NPI Enumeration Date: | 03/31/2010 |
| NPI Last Update Date: | 08/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY20123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |