Provider Demographics
NPI:1790109304
Name:KRAHL, ALYSON (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:KRAHL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:
Other - Last Name:DEPATHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 BENNY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1811
Mailing Address - Country:US
Mailing Address - Phone:860-919-5884
Mailing Address - Fax:
Practice Address - Street 1:104 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1932
Practice Address - Country:US
Practice Address - Phone:630-297-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional