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General NPI Number Information
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NPI Number | 1467815639
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Entity Type | Individual
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Provider Name | ALISSA ANDREA MORTENSON TYKA MA, LMHCA
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Gender | Female
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 2763 152ND AVE NE BUILDING 4A
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City | REDMOND
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State | WA
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Zip | 98052-5555
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Country | US
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Telephone | 425-628-2763
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Fax |
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Provider Business Mailing Address
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Address Line | 910 17TH AVE E
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City | SEATTLE
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State | WA
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Zip | 98112-3924
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Country | US
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Telephone | 206-218-8860
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC 60644454
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License Number State | WA
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