Healthcare Provider Details

I. General information

NPI: 1093672313
Provider Name (Legal Business Name): ALYSSA COFFEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 BREA BLVD STE 132
FULLERTON CA
92835-4123
US

IV. Provider business mailing address

453 S SPRING ST STE 400
LOS ANGELES CA
90013-2074
US

V. Phone/Fax

Practice location:
  • Phone: 714-253-7138
  • Fax:
Mailing address:
  • Phone: 562-270-4876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC17640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: