Provider Demographics
NPI:1790482149
Name:FACIO, ALYSSA (BACHELORS DEGREE)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:FACIO
Suffix:
Gender:F
Credentials:BACHELORS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1651
Mailing Address - Country:US
Mailing Address - Phone:509-759-9825
Mailing Address - Fax:
Practice Address - Street 1:511 S ELM ST
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1651
Practice Address - Country:US
Practice Address - Phone:509-759-9825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA910576806Medicaid