Provider Demographics
NPI:1801451927
Name:COOK, ALYSSA PAIGE (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:PAIGE
Last Name:COOK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:PAIGE
Other - Last Name:COLLICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:22431 ANTONIO PKWY # B160-198
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2804
Mailing Address - Country:US
Mailing Address - Phone:949-838-4804
Mailing Address - Fax:
Practice Address - Street 1:30211 AVENIDA DE LAS BANDERA STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2159
Practice Address - Country:US
Practice Address - Phone:949-838-4804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT111936106H00000X
IDLAMFT-8456106H00000X
CA145095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist