Provider Demographics
NPI:1043296205
Name:LEVY, ALYSSA BEE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:BEE
Last Name:LEVY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 THREE FOUNTAINS DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5260
Mailing Address - Country:US
Mailing Address - Phone:801-963-4292
Mailing Address - Fax:801-963-4299
Practice Address - Street 1:842 THREE FOUNTAINS DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5260
Practice Address - Country:US
Practice Address - Phone:801-963-4292
Practice Address - Fax:801-963-4299
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT952870312501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107001403101Medicare UPIN
UT004662160Medicare PIN
UT942938348LE4Medicare UPIN
UT261758Medicare UPIN