Healthcare Provider Details

I. General information

NPI: 1780134361
Provider Name (Legal Business Name): ALYSSA BEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA LYNN HOLDEN

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 LEE BLVD UNIT 6
LEHIGH ACRES FL
33971-1038
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 239-932-2220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: