Provider Demographics
NPI:1851832216
Name:BOOTH, ALYSSA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:ALBRITTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1840 POPPY MALLOW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 BUSBY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1116
Practice Address - Country:US
Practice Address - Phone:210-464-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional