Provider Demographics
NPI:1295480549
Name:GRAY, ALISSA MADELINE (MA, AMFT, APCC)
Entity type:Individual
Prefix:MISS
First Name:ALISSA
Middle Name:MADELINE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA, AMFT, APCC
Other - Prefix:
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Mailing Address - Street 1:26096 TAMPICO DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3310
Mailing Address - Country:US
Mailing Address - Phone:818-457-6896
Mailing Address - Fax:
Practice Address - Street 1:18646 OXNARD ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1486
Practice Address - Country:US
Practice Address - Phone:818-654-3828
Practice Address - Fax:818-654-3878
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)