Provider Demographics
NPI:1770242430
Name:BEAIRD, ALISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:
Last Name:BEAIRD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 E BOSTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6239
Mailing Address - Country:US
Mailing Address - Phone:480-505-3838
Mailing Address - Fax:480-505-3838
Practice Address - Street 1:1754 E BOSTON ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6238
Practice Address - Country:US
Practice Address - Phone:480-220-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005467103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling