Healthcare Provider Details

I. General information

NPI: 1568366458
Provider Name (Legal Business Name): ALYSSE MCDONOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 21ST AVE W
BRADENTON FL
34209-5641
US

IV. Provider business mailing address

704 PINTAIL CV
BRADENTON FL
34212-2810
US

V. Phone/Fax

Practice location:
  • Phone: 941-778-4888
  • Fax:
Mailing address:
  • Phone: 941-404-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4270
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: