Provider Demographics
NPI:1134556053
Name:ORWELLER, ALYSSA LYNNE (PC)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LYNNE
Last Name:ORWELLER
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 CHAMBERS RD
Mailing Address - Street 2:APT. 125B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1760
Mailing Address - Country:US
Mailing Address - Phone:614-538-0353
Mailing Address - Fax:614-429-3921
Practice Address - Street 1:1335 DUBLIN RD
Practice Address - Street 2:SUITE 208D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1000
Practice Address - Country:US
Practice Address - Phone:614-538-0353
Practice Address - Fax:614-429-3921
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1200578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional