MEDICARE: ALYSSA EICHHORN

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	1370-7-1-24A	ND

General Provider Information

NPI Number	:	1801632807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA EICHHORN

Provider Business Mailing Address
First Line	:	3901 30TH AVE S APT 302
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-7818
Country	:	US
Telephone Number	:	701-430-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	4143 26TH AVE S STE 100
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-7919
Country	:	US
Telephone Number	:	701-639-2937
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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Directions to “ ALYSSA EICHHORN ” Practice Location

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