Provider Demographics
NPI:1720485485
Name:THEWES, ALYSSON MICHELLE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSSON
Middle Name:MICHELLE
Last Name:THEWES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ALYSSON
Other - Middle Name:MICHELLE
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LMSW
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEART
Mailing Address - State:ND
Mailing Address - Zip Code:58655-0025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:139 3RD ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5147
Practice Address - Country:US
Practice Address - Phone:406-991-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT507321041C0700X
NV8278-C1041C0700X
ND66621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101YM0800XMedicaid