Healthcare Provider Details

I. General information

NPI: 1992950018
Provider Name (Legal Business Name): ALLYSON RAYE AGUIRRE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLYSON KELLUM LCSW

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 W. H. ST. SUITE 103
BRAWLEY CA
92227
US

IV. Provider business mailing address

605 W. H. ST. SUITE 103
BRAWLEY CA
92227
US

V. Phone/Fax

Practice location:
  • Phone: 442-279-6490
  • Fax: 951-849-1762
Mailing address:
  • Phone: 442-279-6490
  • Fax: 951-849-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW66162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: