Provider Demographics
NPI:1609493394
Name:COLBERT, ALYSSA RENAE
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:RENAE
Last Name:COLBERT
Suffix:
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 1:6730 4TH AVENUE
Mailing Address - Street 2:APT 914
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2653
Mailing Address - Country:US
Mailing Address - Phone:408-833-2292
Mailing Address - Fax:
Practice Address - Street 1:6730 4TH AVENUE
Practice Address - Street 2:APT 914
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2653
Practice Address - Country:US
Practice Address - Phone:408-833-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician