Provider Demographics
NPI:1477125623
Name:ALLIS, ALICE ALAN-MICHAEL (MSW, LSWAIC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ALAN-MICHAEL
Last Name:ALLIS
Suffix:
Gender:M
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:ALAN-MICHAEL
Other - Middle Name:
Other - Last Name:ALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSWAIC
Mailing Address - Street 1:2120 S PLUM ST STE A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4539
Mailing Address - Country:US
Mailing Address - Phone:206-441-3043
Mailing Address - Fax:
Practice Address - Street 1:2120 S PLUM ST STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4539
Practice Address - Country:US
Practice Address - Phone:206-441-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health