Provider Demographics
NPI:1477801512
Name:MCDONALD, ALISA HAYS (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:HAYS
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12346
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-2346
Mailing Address - Country:US
Mailing Address - Phone:979-219-2217
Mailing Address - Fax:
Practice Address - Street 1:1489 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8446
Practice Address - Country:US
Practice Address - Phone:979-219-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional