Provider Demographics
NPI:1437766888
Name:BLYDEN, ALYSSA S (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:S
Last Name:BLYDEN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 NW 90TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1802
Mailing Address - Country:US
Mailing Address - Phone:757-512-4385
Mailing Address - Fax:
Practice Address - Street 1:4731 S COCHISE DR STE 206
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6975
Practice Address - Country:US
Practice Address - Phone:816-373-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015019944101YP2500X
KS2896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA