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General NPI Number Information
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NPI Number | 1285387340
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Entity Type | Individual
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Provider Name | ALYSSE MARIE FAWCETT LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/30/2022
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 230 N PARK BLVD STE 103
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City | GRAPEVINE
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State | TX
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Zip | 76051-6981
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Country | US
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Telephone | 214-983-6726
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Fax |
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Provider Business Mailing Address
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Address Line | 409 TIMBER RIDGE PKWY
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City | SEVERANCE
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State | CO
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Zip | 80550-2966
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Country | US
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Telephone | 970-218-0010
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0002220
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 203620
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License Number State | TX
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