Provider Demographics
NPI:1235432550
Name:BARBOUR, ALYSHA (LAC)
Entity Type:Individual
Prefix:MS
First Name:ALYSHA
Middle Name:
Last Name:BARBOUR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:ALYSHA
Other - Middle Name:ANAIS
Other - Last Name:BARBOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 1628
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051
Mailing Address - Country:US
Mailing Address - Phone:503-366-7919
Mailing Address - Fax:503-366-2789
Practice Address - Street 1:1561 COLUMBIA BLVD.
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051
Practice Address - Country:US
Practice Address - Phone:503-366-7919
Practice Address - Fax:503-366-2789
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC152747171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500738957Medicaid