Provider Demographics
NPI:1598390643
Name:WITMER, ALYSON HOLMES (LPC, LAMFT)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:HOLMES
Last Name:WITMER
Suffix:
Gender:F
Credentials:LPC, LAMFT
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 6512
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-6512
Mailing Address - Country:US
Mailing Address - Phone:208-720-1023
Mailing Address - Fax:
Practice Address - Street 1:220 2ND AVE
Practice Address - Street 2:STE 201
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-720-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLAMFT-7634106H00000X
IDLPC-7549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist