Provider Demographics
NPI:1861037467
Name:NELSON, ALYSSA ROSE (LMHC, SUDP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ROSE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMHC, SUDP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:OVERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, SUDP
Mailing Address - Street 1:5322 235TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029
Mailing Address - Country:US
Mailing Address - Phone:425-218-2064
Mailing Address - Fax:
Practice Address - Street 1:5322 235TH AVE SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029
Practice Address - Country:US
Practice Address - Phone:425-218-2064
Practice Address - Fax:425-453-5191
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60943639101YM0800X
WACP61361950101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health