Provider Demographics
NPI:1992950018
Name:AGUIRRE, ALLYSON RAYE (LCSW)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:RAYE
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:KELLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:605 W. H. ST.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227
Mailing Address - Country:US
Mailing Address - Phone:442-279-6490
Mailing Address - Fax:951-849-1762
Practice Address - Street 1:605 W. H. ST.
Practice Address - Street 2:SUITE 103
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227
Practice Address - Country:US
Practice Address - Phone:442-279-6490
Practice Address - Fax:951-849-1762
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW661621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical