Individual
ALYSSA ANN FAHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16095 TUSCOLA RD, APPLE VALLEY, CA 92307-1319
(760) 269-4242
Mailing address
8768 MESA RD, LUCERNE VALLEY, CA 92356-8698
(909) 246-9089
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
E3028637
CA
Other
Enumeration date
03/09/2023
Last updated
03/09/2023
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