Healthcare Provider Details

I. General information

NPI: 1790661015
Provider Name (Legal Business Name): ALYSSA HARRIS DEAN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W FREEMAN AVE STE 9
BERRYVILLE AR
72616-3141
US

IV. Provider business mailing address

206 BAKER ST APT A1
BERRYVILLE AR
72616-3800
US

V. Phone/Fax

Practice location:
  • Phone: 870-340-2636
  • Fax:
Mailing address:
  • Phone: 479-981-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA2508009
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2508009
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberA2508009
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA2508009
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: