Provider Demographics
NPI:1194256800
Name:MUSHLITZ, ALLISON (PSYD)
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:
Last Name:MUSHLITZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 POST LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-3218
Mailing Address - Country:US
Mailing Address - Phone:208-305-2053
Mailing Address - Fax:
Practice Address - Street 1:875 PERIMETER DR # MS 3140
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83844-2697
Practice Address - Country:US
Practice Address - Phone:208-885-6716
Practice Address - Fax:208-885-4354
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health