Provider Demographics
NPI:1811752389
Name:MAPLES, ALYSSA
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:MAPLES
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 1:5200 S BLACKSTONE AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-6010
Mailing Address - Country:US
Mailing Address - Phone:763-355-2654
Mailing Address - Fax:
Practice Address - Street 1:970 RAYMOND AVE STE 106
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1164
Practice Address - Country:US
Practice Address - Phone:651-358-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist