Provider Demographics
NPI:1407160732
Name:ALLRED, ALESA
Entity Type:Individual
Prefix:
First Name:ALESA
Middle Name:
Last Name:ALLRED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 E 100 S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-3001
Mailing Address - Country:US
Mailing Address - Phone:435-673-2211
Mailing Address - Fax:
Practice Address - Street 1:1240 E 100 S
Practice Address - Street 2:SUITE 202
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-3001
Practice Address - Country:US
Practice Address - Phone:435-673-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst