Individual
ALLYSE MARIE IDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TLLP
Contact information
Practice address
830 PLEASANT ST STE 201, SAINT JOSEPH, MI 49085-2279
(269) 982-3832
Mailing address
830 PLEASANT ST STE 201, SAINT JOSEPH, MI 49085-2279
(269) 982-3832
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6362009552
MI
Other
Enumeration date
06/13/2022
Last updated
06/13/2022
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