Provider Demographics
NPI:1326877101
Name:PACKDELL, ALYSSA A (COUNSELOR)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:PACKDELL
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 NE DELAMERE WAY # NA
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-9227
Mailing Address - Country:US
Mailing Address - Phone:971-444-9191
Mailing Address - Fax:
Practice Address - Street 1:9620 NE TANASBOURNE DR STE 300
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7844
Practice Address - Country:US
Practice Address - Phone:541-975-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional