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General NPI Number Information
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NPI Number | 1760397384
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Entity Type | Individual
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Provider Name | ALYSSA LAISURE
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Gender |
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 1280 CHARLES LN
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City | MARYSVILLE
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State | OH
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Zip | 43040-9797
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Country | US
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Telephone | 937-578-6704
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Fax |
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Provider Business Mailing Address
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Address Line | 6857 JENNIFER ANN DR
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City | LEWIS CENTER
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State | OH
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Zip | 43035-7119
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LSP.03124
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License Number State | OH
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