Provider Demographics
NPI:1205269719
Name:DOBERSTEIN, ALYSSA MARIE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:DOBERSTEIN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17164 POLK ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2285
Mailing Address - Country:US
Mailing Address - Phone:763-226-0604
Mailing Address - Fax:
Practice Address - Street 1:2705 BUNKER LAKE BLVD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3784
Practice Address - Country:US
Practice Address - Phone:763-482-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2484106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist