Provider Demographics
NPI:1982202651
Name:FOBES, ALYSSA BELLE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BELLE
Last Name:FOBES
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 1:21709 146TH ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7543
Mailing Address - Country:US
Mailing Address - Phone:253-677-4808
Mailing Address - Fax:
Practice Address - Street 1:111 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1108
Practice Address - Country:US
Practice Address - Phone:360-240-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician