Healthcare Provider Details

I. General information

NPI: 1811533912
Provider Name (Legal Business Name): ALYSSA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2019
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 VINE ST
CINCINNATI OH
45219-1745
US

IV. Provider business mailing address

2347 VINE ST
CINCINNATI OH
45219-1745
US

V. Phone/Fax

Practice location:
  • Phone: 513-621-1117
  • Fax:
Mailing address:
  • Phone: 513-621-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2103341
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: