Healthcare Provider Details

I. General information

NPI: 1730633074
Provider Name (Legal Business Name): ALYSSA CLOSE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 COMMERCIAL ST SE
SALEM OR
97302-5154
US

IV. Provider business mailing address

1705 COMMERCIAL ST SE
SALEM OR
97302-5154
US

V. Phone/Fax

Practice location:
  • Phone: 541-209-6639
  • Fax:
Mailing address:
  • Phone: 541-209-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5510
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: