Provider Demographics
NPI:1164169538
Name:ALYSSA CARL PC
Entity Type:Organization
Organization Name:ALYSSA CARL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:517-410-6093
Mailing Address - Street 1:55934 TETON CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-8795
Mailing Address - Country:US
Mailing Address - Phone:517-410-6093
Mailing Address - Fax:888-676-9051
Practice Address - Street 1:225 N NOTRE DAME AVE STE 5
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2836
Practice Address - Country:US
Practice Address - Phone:517-410-6093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty