Provider Demographics
NPI:1790338739
Name:BALONIS, ALYSHA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:MARIE
Last Name:BALONIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALYSHA
Other - Middle Name:MARIE
Other - Last Name:BIXLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:704 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:TOWER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:17980-1216
Mailing Address - Country:US
Mailing Address - Phone:717-991-3310
Mailing Address - Fax:
Practice Address - Street 1:704 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:TOWER CITY
Practice Address - State:PA
Practice Address - Zip Code:17980-1216
Practice Address - Country:US
Practice Address - Phone:717-461-2014
Practice Address - Fax:717-647-2573
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036767410003Medicaid