Healthcare Provider Details

I. General information

NPI: 1548922263
Provider Name (Legal Business Name): ALYSSA KATHRYN HAHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COURT ST SE STE 204
LIVE OAK FL
32064-3223
US

IV. Provider business mailing address

2129 NE DELPHINIUM DR
MADISON FL
32340-5234
US

V. Phone/Fax

Practice location:
  • Phone: 386-222-2832
  • Fax:
Mailing address:
  • Phone: 386-222-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: