Provider Demographics
NPI:1780329714
Name:ALVERSON, MYESHA
Entity type:Individual
Prefix:
First Name:MYESHA
Middle Name:
Last Name:ALVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11807 LONG BEACH BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4322
Mailing Address - Country:US
Mailing Address - Phone:562-841-3299
Mailing Address - Fax:
Practice Address - Street 1:11807 LONG BEACH BLVD APT A
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4322
Practice Address - Country:US
Practice Address - Phone:562-841-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician