Provider Demographics
NPI:1598288805
Name:LILJEGRENOLSSON, ALISHA LEIGH (PSYD)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:LEIGH
Last Name:LILJEGRENOLSSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:LEIGH
Other - Last Name:VANSCHOYCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS COUSNELING
Mailing Address - Street 1:933 FRED BURR RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875-9570
Mailing Address - Country:US
Mailing Address - Phone:805-478-1298
Mailing Address - Fax:
Practice Address - Street 1:933 FRED BURR RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:MT
Practice Address - Zip Code:59875-9570
Practice Address - Country:US
Practice Address - Phone:905-478-1298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2024-01-23
Deactivation Date:2022-05-03
Deactivation Code:
Reactivation Date:2022-06-03
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025111390200000X
MTBBH-LCPC-LIC-64913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program