Healthcare Provider Details

I. General information

NPI: 1104173566
Provider Name (Legal Business Name): ALYSSA MONTAGUE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA LIMBERG

II. Dates (important events)

Enumeration Date: 08/04/2012
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 N SAGINAW RD
MIDLAND MI
48640
US

IV. Provider business mailing address

133 N SAGINAW RD
MIDLAND MI
48640-3350
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-0241
  • Fax:
Mailing address:
  • Phone: 989-631-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013185
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: