Provider Demographics
NPI:1164845319
Name:PENA, ALYSON (LPCC #4250)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:LPCC #4250
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 N PAGEANT DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-7601
Mailing Address - Country:US
Mailing Address - Phone:949-374-2323
Mailing Address - Fax:714-289-3938
Practice Address - Street 1:5000 BIRCH ST STE 1400
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2150
Practice Address - Country:US
Practice Address - Phone:949-374-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health