Healthcare Provider Details

I. General information

NPI: 1194405936
Provider Name (Legal Business Name): ALYSSA RENEE BALLIS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1588 DOUGLAS AVE
CLOVIS CA
93611-3124
US

IV. Provider business mailing address

1588 DOUGLAS AVE
CLOVIS CA
93611-3124
US

V. Phone/Fax

Practice location:
  • Phone: 559-392-3371
  • Fax:
Mailing address:
  • Phone: 559-392-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number163875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: