Provider Demographics
NPI:1376255992
Name:MARCELLETTI, ALYSHIA (AMFT APCC, NDTR)
Entity type:Individual
Prefix:
First Name:ALYSHIA
Middle Name:
Last Name:MARCELLETTI
Suffix:
Gender:F
Credentials:AMFT APCC, NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2442
Mailing Address - Country:US
Mailing Address - Phone:323-334-0937
Mailing Address - Fax:
Practice Address - Street 1:17609 VENTURA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5128
Practice Address - Country:US
Practice Address - Phone:310-494-6241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1491751222101YA0400X
CA147455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)