Provider Demographics
NPI:1003381161
Name:KIRKMAN, ALYSSA MICHELLE (MS, EDS, LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:KIRKMAN
Suffix:
Gender:F
Credentials:MS, EDS, LMHCA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MICHELLE
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1823 MINOR AVE APT 1506
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-0924
Mailing Address - Country:US
Mailing Address - Phone:501-779-8321
Mailing Address - Fax:
Practice Address - Street 1:602 VALLEY ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4228
Practice Address - Country:US
Practice Address - Phone:501-779-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60868635101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604335707OtherWASHINGTON SECRETARY OF STATE
MC6086835OtherWASHINGTON DEPARTMENT OF HEALTH