Healthcare Provider Details

I. General information

NPI: 1598288805
Provider Name (Legal Business Name): ALISHA LEIGH LILJEGRENOLSSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISHA LEIGH VANSCHOYCK MS COUSNELING

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date: 05/03/2022
Reactivation Date: 06/03/2022

III. Provider practice location address

933 FRED BURR RD
VICTOR MT
59875-9570
US

IV. Provider business mailing address

933 FRED BURR RD
VICTOR MT
59875-9570
US

V. Phone/Fax

Practice location:
  • Phone: 905-478-1298
  • Fax:
Mailing address:
  • Phone: 805-478-1298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-LCPC-LIC-64913
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSB94025111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: