Provider Demographics
NPI:1023633385
Name:CALLAHAN, ALYSSA SARAH JO
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SARAH JO
Last Name:CALLAHAN
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 1:606 LILLY RD NE APT 135
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5142
Mailing Address - Country:US
Mailing Address - Phone:360-489-2245
Mailing Address - Fax:
Practice Address - Street 1:605 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1045
Practice Address - Country:US
Practice Address - Phone:360-456-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst