Provider Demographics
NPI:1659635985
Name:ALLISON, ALYSON BROOKE
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:BROOKE
Last Name:ALLISON
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-0128
Mailing Address - Country:US
Mailing Address - Phone:805-441-0775
Mailing Address - Fax:
Practice Address - Street 1:1264 HIGUERA ST
Practice Address - Street 2:108A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3124
Practice Address - Country:US
Practice Address - Phone:805-441-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-08-4167 BCBA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst