Provider Demographics
NPI:1609491620
Name:ASBURY, ALYSSA
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:ASBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:B
Other - Last Name:REMIGIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1538 W MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1445
Mailing Address - Country:US
Mailing Address - Phone:559-793-6726
Mailing Address - Fax:
Practice Address - Street 1:325 MALL DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5950
Practice Address - Country:US
Practice Address - Phone:559-485-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician