Provider Demographics
NPI:1841330685
Name:BOYER, ALYSSA SHAWN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:SHAWN
Last Name:BOYER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 E 32ND ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-3331
Mailing Address - Country:US
Mailing Address - Phone:316-869-2888
Mailing Address - Fax:
Practice Address - Street 1:8623 E 32ND ST N STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-3331
Practice Address - Country:US
Practice Address - Phone:316-869-2888
Practice Address - Fax:316-425-5550
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC 776101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS203228795OtherTIN