Healthcare Provider Details

I. General information

NPI: 1508333071
Provider Name (Legal Business Name): ALYSA REY MICKEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 S COWLEY ST STE 9
SPOKANE WA
99202-1263
US

IV. Provider business mailing address

922 S COWLEY ST STE 9
SPOKANE WA
99202-1263
US

V. Phone/Fax

Practice location:
  • Phone: 509-822-6777
  • Fax: 509-676-6655
Mailing address:
  • Phone: 509-822-6777
  • Fax: 509-676-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60797144
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61539180
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: