Healthcare Provider Details

I. General information

NPI: 1861304602
Provider Name (Legal Business Name): ALYSIA DODGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 W ORANGE GROVE RD STE 3
TUCSON AZ
85741-2869
US

IV. Provider business mailing address

721 N DODGE DR
THATCHER AZ
85552-5677
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-1136
  • Fax:
Mailing address:
  • Phone: 928-965-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: