Provider Demographics
NPI:1932655990
Name:AYAMA PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:AYAMA PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:YAMASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-470-1868
Mailing Address - Street 1:80 CORNFIELD LN
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-8335
Mailing Address - Country:US
Mailing Address - Phone:814-470-1868
Mailing Address - Fax:
Practice Address - Street 1:720 PIKE ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:PA
Practice Address - Zip Code:16851
Practice Address - Country:US
Practice Address - Phone:814-470-1868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016376103T00000X
PAPS018048103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty