Provider Demographics
NPI:1447740436
Name:HUTTEL, ALYSSA (MSED, LPCC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:HUTTEL
Suffix:
Gender:F
Credentials:MSED, LPCC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5344 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3678
Mailing Address - Country:US
Mailing Address - Phone:218-260-5490
Mailing Address - Fax:
Practice Address - Street 1:324 W SUPERIOR ST STE 530
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1724
Practice Address - Country:US
Practice Address - Phone:218-464-7674
Practice Address - Fax:218-600-5009
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician