Provider Demographics
NPI:1184093742
Name:WALDMER, ALYSSA (LAC, MFT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:WALDMER
Suffix:
Gender:F
Credentials:LAC, MFT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:MORRISSETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, MFTC
Mailing Address - Street 1:4856 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5539
Mailing Address - Country:US
Mailing Address - Phone:970-494-4200
Mailing Address - Fax:970-613-4475
Practice Address - Street 1:4856 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5539
Practice Address - Country:US
Practice Address - Phone:970-494-4200
Practice Address - Fax:970-613-4475
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000816101YA0400X
COMFT.0002489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)