Healthcare Provider Details

I. General information

NPI: 1447180096
Provider Name (Legal Business Name): ALYSSA GAIL DURANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4072 PRIMROSE PL APT 34
BEAVERCREEK OH
45431-2385
US

IV. Provider business mailing address

4072 PRIMROSE PL APT 34
BEAVERCREEK OH
45431-2385
US

V. Phone/Fax

Practice location:
  • Phone: 937-313-9742
  • Fax:
Mailing address:
  • Phone: 937-313-9742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberUV975498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: