Provider Demographics
NPI:1851191464
Name:COPENHAVER, ALYSA MARI (LCSW)
Entity type:Individual
Prefix:
First Name:ALYSA
Middle Name:MARI
Last Name:COPENHAVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALYSA
Other - Middle Name:MARI
Other - Last Name:GARRIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:5611 LIBERTY CREEK DR E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1003
Mailing Address - Country:US
Mailing Address - Phone:765-491-5020
Mailing Address - Fax:
Practice Address - Street 1:8401 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2073
Practice Address - Country:US
Practice Address - Phone:317-338-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011853A1041C0700X
IN33011218A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical