Provider Demographics
NPI:1558044420
Name:MECHEM, ALYSSA MERCEDES I
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MERCEDES
Last Name:MECHEM
Suffix:I
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 1:8722 BURTON WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3854
Mailing Address - Country:US
Mailing Address - Phone:559-436-9603
Mailing Address - Fax:
Practice Address - Street 1:12100 WILSHIRE BLVD STE 836
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7120
Practice Address - Country:US
Practice Address - Phone:310-905-6642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician