Provider Demographics
NPI:1891494464
Name:ALVEY, LISA (RMHI)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ALVEY
Suffix:
Gender:F
Credentials:RMHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 MAR WALT DR STE 2022
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6631
Mailing Address - Country:US
Mailing Address - Phone:850-243-0095
Mailing Address - Fax:850-374-3192
Practice Address - Street 1:907 MAR WALT DR STE 2022
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6631
Practice Address - Country:US
Practice Address - Phone:850-243-0095
Practice Address - Fax:850-374-3192
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22379390200000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22379OtherREGISTERED MENTAL HEALTH COUNSELOR INTERN