Provider Demographics
NPI:1306124276
Name:BRIN, ALYSSA (LPC, CN)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BRIN
Suffix:
Gender:F
Credentials:LPC, CN
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:C
Other - Last Name:PELHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CN, LMHCA, LPC-ASSOC
Mailing Address - Street 1:12636 SE STARK ST BLDG J
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1058
Mailing Address - Country:US
Mailing Address - Phone:503-253-4600
Mailing Address - Fax:
Practice Address - Street 1:12636 SE STARK ST BLDG J
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1058
Practice Address - Country:US
Practice Address - Phone:503-253-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60324012133N00000X
ORC7809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist