Healthcare Provider Details

I. General information

NPI: 1932019114
Provider Name (Legal Business Name): ALYSSA RAVEN MERGIST PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19295 N 3RD ST
COVINGTON LA
70433-8897
US

IV. Provider business mailing address

719 LIONEL CT
ABITA SPRINGS LA
70420-3087
US

V. Phone/Fax

Practice location:
  • Phone: 225-409-2409
  • Fax:
Mailing address:
  • Phone: 985-251-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC11486
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: