Provider Demographics
NPI:1922572718
Name:WEBB, ALYSSA A
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 JUHL RD
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-8992
Mailing Address - Country:US
Mailing Address - Phone:810-858-9201
Mailing Address - Fax:
Practice Address - Street 1:1363 DOUGLAS DR STE 104
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-8980
Practice Address - Country:US
Practice Address - Phone:231-668-4909
Practice Address - Fax:231-943-1334
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician