Healthcare Provider Details

I. General information

NPI: 1750866695
Provider Name (Legal Business Name): MRS. ALYSSA RENEE WILD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA RENEE WILD MA, AMFT

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 EAST PKWY
SACRAMENTO CA
95823-2501
US

IV. Provider business mailing address

7001 EAST PKWY
SACRAMENTO CA
95823-2501
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-5881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-65938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: