Provider Demographics
NPI:1790661015
Name:DEAN, ALYSSA HARRIS (LAC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:HARRIS
Last Name:DEAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BAKER ST APT A1
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-3800
Mailing Address - Country:US
Mailing Address - Phone:479-981-6993
Mailing Address - Fax:
Practice Address - Street 1:804 W FREEMAN AVE STE 9
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-3141
Practice Address - Country:US
Practice Address - Phone:870-340-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2508009101YA0400X, 101YM0800X, 101YS0200X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool