Provider Demographics
NPI:1558032441
Name:GOSS, ALYSIA BRIANNA
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:BRIANNA
Last Name:GOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 W BROOMFIELD ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4578
Mailing Address - Country:US
Mailing Address - Phone:989-289-1572
Mailing Address - Fax:
Practice Address - Street 1:2850 W CHEESMAN RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-8757
Practice Address - Country:US
Practice Address - Phone:989-285-1692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician