Provider Demographics
NPI:1689201352
Name:NYBERG, ALYSSA MARY (MPS, LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARY
Last Name:NYBERG
Suffix:
Gender:F
Credentials:MPS, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 WINNETKA AVE N STE 1010
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2853
Mailing Address - Country:US
Mailing Address - Phone:763-541-4993
Mailing Address - Fax:763-541-5324
Practice Address - Street 1:2960 WINNETKA AVE N STE 1010
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55427-2853
Practice Address - Country:US
Practice Address - Phone:763-541-4993
Practice Address - Fax:763-541-5324
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303833101YA0400X
MNCC01716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)