Provider Demographics
NPI:1134839087
Name:MITCHEM, ALYSSA C (LCSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:C
Last Name:MITCHEM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2324
Mailing Address - Country:US
Mailing Address - Phone:260-223-2273
Mailing Address - Fax:
Practice Address - Street 1:2208 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2324
Practice Address - Country:US
Practice Address - Phone:260-223-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical