Provider Demographics
NPI:1881017176
Name:BETRES, ALYSIA ANNE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:ALYSIA
Middle Name:ANNE
Last Name:BETRES
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C11 FOREST HTS
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-3983
Mailing Address - Country:US
Mailing Address - Phone:252-202-8857
Mailing Address - Fax:
Practice Address - Street 1:C11 FOREST HTS
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-3983
Practice Address - Country:US
Practice Address - Phone:252-202-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PC007348101YP2500X
PAPC007348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1881017176Medicaid