Provider Demographics
NPI:1699287672
Name:NEWMAN, ALYSSA J (LCPC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:J
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:J
Other - Last Name:BROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:444 HOSPITAL WAY STE 477
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2744
Mailing Address - Country:US
Mailing Address - Phone:208-233-7832
Mailing Address - Fax:208-234-2646
Practice Address - Street 1:444 HOSPITAL WAY STE 477
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2744
Practice Address - Country:US
Practice Address - Phone:208-233-7832
Practice Address - Fax:208-233-7835
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-10540101Y00000X
IDLPC-6717101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor