Healthcare Provider Details

I. General information

NPI: 1225568140
Provider Name (Legal Business Name): ALYSSA ELLEN ANDREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E PIONEER
PUYALLUP WA
98372
US

IV. Provider business mailing address

325 E PIONEER
PUYALLUP WA
98372-3265
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-8400
  • Fax: 253-697-8452
Mailing address:
  • Phone: 253-697-8400
  • Fax: 253-697-8452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60928310
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: