Provider Demographics
NPI:1407400245
Name:WEIDMAN, ALYSSA (MA, LPC, NCC, CAS)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:WEIDMAN
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1941
Mailing Address - Country:US
Mailing Address - Phone:720-334-7648
Mailing Address - Fax:
Practice Address - Street 1:1460 PIERCE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-1941
Practice Address - Country:US
Practice Address - Phone:720-334-7648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015514101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC.0015514OtherLICENSE NUMBER