Provider Demographics
NPI:1659896223
Name:THULL, ALISHA CHARISE
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:CHARISE
Last Name:THULL
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 1:2250 W. CLINTON AVE
Mailing Address - Street 2:BUILDING B #128
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705
Mailing Address - Country:US
Mailing Address - Phone:559-245-1161
Mailing Address - Fax:
Practice Address - Street 1:3333 E AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9247
Practice Address - Country:US
Practice Address - Phone:559-600-4879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0000880620101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)