Healthcare Provider Details

I. General information

NPI: 1154892628
Provider Name (Legal Business Name): ALYSSA JOYCE MARIE SENZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N RANDALL AVE STE A
JANESVILLE WI
53545-1958
US

IV. Provider business mailing address

612 N RANDALL AVE STE A
JANESVILLE WI
53545-1958
US

V. Phone/Fax

Practice location:
  • Phone: 608-752-7660
  • Fax:
Mailing address:
  • Phone: 608-752-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1013
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: