Provider Demographics
NPI:1245880046
Name:YOUNG, ALISSA
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BEVERLY BLVD APT 520
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5247
Mailing Address - Country:US
Mailing Address - Phone:424-206-0099
Mailing Address - Fax:
Practice Address - Street 1:1800 BEVERLY BLVD APT 520
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-5247
Practice Address - Country:US
Practice Address - Phone:424-206-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2025-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91617101YM0800X
CA115163101YM0800X
CAASW91617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health