1174542567 NPI number — MS. ALYSSA ANN WRIGHT LMFT

Table of content: MS. ALYSSA ANN WRIGHT LMFT (NPI 1174542567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174542567 NPI number — MS. ALYSSA ANN WRIGHT LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
ALYSSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLEVENGER
Provider Other First Name:
ALYSSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174542567
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 CLEVELAND AVENUE N.
Provider Second Line Business Mailing Address:
SUITE 316
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-524-9661
Provider Business Mailing Address Fax Number:
651-330-3581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 CLEVELAND AVENUE N.
Provider Second Line Business Practice Location Address:
SUITE 316
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-330-3434
Provider Business Practice Location Address Fax Number:
651-330-3581
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1539 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 067948800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411576550 . This is a "PRACTICE LOCATION TAX ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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