Provider Demographics
NPI:1962053355
Name:MISSLER, ALYSSA ROSE (LCDCIII)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ROSE
Last Name:MISSLER
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3021
Mailing Address - Country:US
Mailing Address - Phone:567-280-4023
Mailing Address - Fax:
Practice Address - Street 1:3055 S STATE ROUTE 100
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8868
Practice Address - Country:US
Practice Address - Phone:419-477-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)