Provider Demographics
NPI:1811446396
Name:GILDEN, ALYSSA (PHD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:GILDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13204 AMARILLO AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7576
Mailing Address - Country:US
Mailing Address - Phone:919-360-5351
Mailing Address - Fax:
Practice Address - Street 1:7700 CAT HOLLOW DR
Practice Address - Street 2:SUITE 206
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5796
Practice Address - Country:US
Practice Address - Phone:512-807-8457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37078103T00000X
TX70649103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool