Healthcare Provider Details

I. General information

NPI: 1467296822
Provider Name (Legal Business Name): ALYSSA MARIE WHITTEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14040 N CAVE CREEK RD STE 104
PHOENIX AZ
85022-6117
US

IV. Provider business mailing address

6635 W HAPPY VALLEY RD STE A104-621
GLENDALE AZ
85310-2609
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-7073
  • Fax: 888-927-0409
Mailing address:
  • Phone: 602-358-7073
  • Fax: 888-927-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-22142
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: