MEDICARE: ALYSSA PAGE LOUNSBERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619594595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA PAGE LOUNSBERRY

Provider Business Mailing Address
First Line	:	3613 N 5TH AVE # 13C2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3701
Country	:	US
Telephone Number	:	602-284-1748
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 E MONTEREY WAY # 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2753
Country	:	US
Telephone Number	:	480-641-1165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	06/26/2020

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Directions to “ ALYSSA PAGE LOUNSBERRY ” Practice Location

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