Healthcare Provider Details

I. General information

NPI: 1356826853
Provider Name (Legal Business Name): ALYSSA JADE CRAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49242 HIGHWAY 445
LORANGER LA
70446-3149
US

IV. Provider business mailing address

53483 ERNEST CRAIN RD
FRANKLINTON LA
70438-6563
US

V. Phone/Fax

Practice location:
  • Phone: 985-606-9900
  • Fax:
Mailing address:
  • Phone: 985-264-8355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9014
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: