Provider Demographics
NPI:1245922491
Name:PESCHO, ALYSON (CT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:PESCHO
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 MAYFIELD RD APT 377
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2220
Mailing Address - Country:US
Mailing Address - Phone:216-645-4131
Mailing Address - Fax:
Practice Address - Street 1:6700 BETA DR STE 108
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2335
Practice Address - Country:US
Practice Address - Phone:440-460-0140
Practice Address - Fax:440-460-5413
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2304922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health