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General NPI Number Information
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NPI Number | 1508333071
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Entity Type | Individual
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Provider Name | ALYSA REY MICKEY LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 922 S COWLEY ST STE 9
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City | SPOKANE
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State | WA
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Zip | 99202-1263
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Country | US
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Telephone | 509-822-6777
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Fax | 509-676-6655
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Provider Business Mailing Address
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Address Line | 922 S COWLEY ST STE 9
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City | SPOKANE
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State | WA
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Zip | 99202-1263
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Country | US
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Telephone | 509-822-6777
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Fax | 509-676-6655
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CG60797144
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW61539180
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License Number State | WA
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