Provider Demographics
NPI:1366906562
Name:GREEN, ALYSSA ASHLEY (MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:ASHLEY
Last Name:GREEN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 LAS PALMAS DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2315
Mailing Address - Country:US
Mailing Address - Phone:909-938-4952
Mailing Address - Fax:
Practice Address - Street 1:101 S KRAEMER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6109
Practice Address - Country:US
Practice Address - Phone:171-499-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist