Provider Demographics
NPI:1437712759
Name:LASOV, ALISON BRYN (LMFT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:BRYN
Last Name:LASOV
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:BRYN
Other - Last Name:FUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:550 S BARRINGTON AVE APT 4315
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4343
Mailing Address - Country:US
Mailing Address - Phone:818-324-2875
Mailing Address - Fax:
Practice Address - Street 1:1600 MAIN ST
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3626
Practice Address - Country:US
Practice Address - Phone:818-324-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88188106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist