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NPI Code Detail

MEDICARE: ALYSSA COLLINS BCBA

MEDICARE: ALYSSA COLLINS BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1194116400
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA COLLINS BCBA
Provider Business Mailing Address
First Line : PO BOX 33568
Second Line :
City : SAN DIEGO
State : CA
Zip : 92163-3568
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 1425 N MCDOWELL BLVD STE 206
Second Line :
City : PETALUMA
State : CA
Zip : 94954-6525
Country : US
Telephone Number : 855-223-7123
Fax Number : 714-784-7516
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2015
Last Update Date : 05/10/2024

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