Healthcare Provider Details

I. General information

NPI: 1184136095
Provider Name (Legal Business Name): ALYSSA ANDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W HARVARD ST STE A
FORT COLLINS CO
80525-5218
US

IV. Provider business mailing address

110 W HARVARD ST STE A
FORT COLLINS CO
80525-5218
US

V. Phone/Fax

Practice location:
  • Phone: 970-402-8543
  • Fax: 970-341-2032
Mailing address:
  • Phone: 970-413-2264
  • Fax: 970-341-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10018758
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1700798
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: