Individual
ALYSSA MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1015 CHAMPIONS DR # 123, ALEDO, TX 76008-3206
(512) 922-0817
Mailing address
1015 CHAMPIONS DR # 123, ALEDO, TX 76008-3206
(512) 922-0817
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
80415
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88-2866187
SELF PAY
TX
Enumeration date
10/06/2022
Last updated
10/06/2022
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