Provider Demographics
NPI:1164200218
Name:COLEMAN, ALYSSA (MA, NCSP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MA, NCSP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:DIETRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31318 CAPELLA CIR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4076
Mailing Address - Country:US
Mailing Address - Phone:281-734-1182
Mailing Address - Fax:
Practice Address - Street 1:32100 DOBBIN HUFFSMITH RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-6389
Practice Address - Country:US
Practice Address - Phone:936-297-0417
Practice Address - Fax:832-218-5858
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34386103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool