Provider Demographics
NPI:1558062505
Name:DIETZ, ALYSSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:DIETZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2920
Mailing Address - Country:US
Mailing Address - Phone:214-620-1405
Mailing Address - Fax:
Practice Address - Street 1:307 E 1ST ST
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2920
Practice Address - Country:US
Practice Address - Phone:214-620-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38102103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral