Healthcare Provider Details

I. General information

NPI: 1942843289
Provider Name (Legal Business Name): DAISY LAROT ALAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 S STATE ST STE 103
UKIAH CA
95482-5833
US

IV. Provider business mailing address

776 S STATE ST STE 103
UKIAH CA
95482-5833
US

V. Phone/Fax

Practice location:
  • Phone: 707-510-7764
  • Fax:
Mailing address:
  • Phone: 707-510-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC7744
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22241
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberAPCC7744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: