Provider Demographics
NPI:1164969374
Name:NYSTROM, ALLISON (LMHP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:NYSTROM
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 S MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5709
Mailing Address - Country:US
Mailing Address - Phone:509-293-3378
Mailing Address - Fax:509-888-2060
Practice Address - Street 1:113 2ND ST STE 7
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2245
Practice Address - Country:US
Practice Address - Phone:509-293-3378
Practice Address - Fax:509-888-2060
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60143068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health