Provider Demographics
NPI:1902211998
Name:FEARNOW-BAURHENN, ALLYSA (LMSW, CADC)
Entity Type:Individual
Prefix:
First Name:ALLYSA
Middle Name:
Last Name:FEARNOW-BAURHENN
Suffix:
Gender:F
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:ALLYSA
Other - Middle Name:
Other - Last Name:FEARNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:6800 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1167
Mailing Address - Country:US
Mailing Address - Phone:586-619-9986
Mailing Address - Fax:
Practice Address - Street 1:18 MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-7403
Practice Address - Country:US
Practice Address - Phone:586-783-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2022-03-23
Deactivation Date:2021-08-13
Deactivation Code:
Reactivation Date:2021-09-23
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI68011093471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)