Provider Demographics
NPI:1093201337
Name:WEBSTER, ALYSON MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:MARIE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 AMMON PARK DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4591
Mailing Address - Country:US
Mailing Address - Phone:208-516-1003
Mailing Address - Fax:208-516-1014
Practice Address - Street 1:1329 AMMON PARK DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4591
Practice Address - Country:US
Practice Address - Phone:208-516-1003
Practice Address - Fax:208-516-1014
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6903101YM0800X
IDLCPC-8326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health