Provider Demographics
NPI:1285387340
Name:FAWCETT, ALYSSE MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ALYSSE
Middle Name:MARIE
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 TIMBER RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2966
Mailing Address - Country:US
Mailing Address - Phone:970-218-0010
Mailing Address - Fax:
Practice Address - Street 1:230 N PARK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-6981
Practice Address - Country:US
Practice Address - Phone:214-983-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002220106H00000X
TX203620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist