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Individual

ALYSE JEANNE LAVERNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMFT

Contact information

Practice address
3429 RENNER DR, FORTUNA, CA 95540-3104
(707) 617-0323
Mailing address
PO BOX 282, FORTUNA, CA 95540-0282
(707) 826-1086

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
AMFT114196
CA

Other

Enumeration date
05/26/2020
Last updated
01/10/2025
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