Healthcare Provider Details

I. General information

NPI: 1235829953
Provider Name (Legal Business Name): ALYSSA HUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N STATE ST
UKIAH CA
95482-3410
US

IV. Provider business mailing address

PO BOX 2077
UKIAH CA
95482-2077
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-7267
  • Fax:
Mailing address:
  • Phone: 707-467-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: