Provider Demographics
NPI:1346994514
Name:EVANS, ALYSSA (LPC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 VERDE VALLEY LN APT 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7496
Mailing Address - Country:US
Mailing Address - Phone:817-372-5708
Mailing Address - Fax:
Practice Address - Street 1:5100 VERDE VALLEY LN APT 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7496
Practice Address - Country:US
Practice Address - Phone:817-372-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty