Basic Information
| Provider Information | |||||||||
| NPI: | 1982059465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | RANE | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 290 | ||||||||
| Address2: | |||||||||
| City: | UHRICHSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446830290 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 117 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | UHRICHSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409222144 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2016 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S 1502448 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | I.2203682 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.