Provider Demographics
NPI:1215612544
Name:ALVIS, JUSTIN (CO 61326791)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:ALVIS
Suffix:
Gender:M
Credentials:CO 61326791
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 196TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7010
Mailing Address - Country:US
Mailing Address - Phone:414-269-4335
Mailing Address - Fax:
Practice Address - Street 1:2322 196TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7010
Practice Address - Country:US
Practice Address - Phone:414-269-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61326791101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)