Provider Demographics
NPI:1679066831
Name:WESTOVER, ALISA RENEE (MA)
Entity Type:Individual
Prefix:MS
First Name:ALISA
Middle Name:RENEE
Last Name:WESTOVER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 36TH ST # 117
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6580
Mailing Address - Country:US
Mailing Address - Phone:360-788-4600
Mailing Address - Fax:
Practice Address - Street 1:1601 F ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-788-4600
Practice Address - Fax:360-788-4949
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60847891103TC1900X
WALH61106182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling