Provider Demographics
NPI:1629617303
Name:BLYTHE, ALYANA (LACMH)
Entity Type:Individual
Prefix:
First Name:ALYANA
Middle Name:
Last Name:BLYTHE
Suffix:
Gender:F
Credentials:LACMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 VILLAS DR APT 5
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-2808
Mailing Address - Country:US
Mailing Address - Phone:302-229-1838
Mailing Address - Fax:
Practice Address - Street 1:115 N BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1045
Practice Address - Country:US
Practice Address - Phone:302-781-3104
Practice Address - Fax:888-977-1773
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAC-0000284101YM0800X
DEPC-0011126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health