Provider Demographics
NPI:1972256899
Name:BURLAKOV, ALISA STEPHANY (LMSW)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:STEPHANY
Last Name:BURLAKOV
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18902 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8753
Mailing Address - Country:US
Mailing Address - Phone:509-979-2371
Mailing Address - Fax:
Practice Address - Street 1:704 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7559
Practice Address - Country:US
Practice Address - Phone:208-676-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-41761104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker