Healthcare Provider Details

I. General information

NPI: 1558088955
Provider Name (Legal Business Name): ALYSSA WESLEY M.A., LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4467 CASCASE RD. SE #4480
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

1303 WEALTHY ST SE FL 1
GRAND RAPIDS MI
49506-2563
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-3784
  • Fax:
Mailing address:
  • Phone: 248-320-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: