Provider Demographics
NPI:1063044741
Name:THOMPSON TOLOSA, ALYSSA N (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:N
Last Name:THOMPSON TOLOSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:N
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 ALMADEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-1610
Mailing Address - Country:US
Mailing Address - Phone:408-608-8063
Mailing Address - Fax:
Practice Address - Street 1:32 RYLAND PARK DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-2249
Practice Address - Country:US
Practice Address - Phone:408-608-8063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA88565OtherLCSW LICENSE NUMBER