Provider Demographics
NPI:1730973728
Name:MATHEWSON, ALYSON (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:MATHEWSON
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 FALCONBERG DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2373
Mailing Address - Country:US
Mailing Address - Phone:909-225-6852
Mailing Address - Fax:
Practice Address - Street 1:4025 LIONCREST LN
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-2945
Practice Address - Country:US
Practice Address - Phone:909-225-6852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000754835103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool