Individual provider Active NPI

Alyssa Ann Wright, LMFT

  • Marriage & Family Therapist
  • Saint Paul, MN
National Provider Identifier
1174542567
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
1539 Issued in MN
Practice address
475 Cleveland Avenue N.
Suite 316
Saint Paul, MN 55104
Phone
(651) 330-3434
Fax
(651) 330-3581
NPI assigned
Jul 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 1539 MN Primary

Addresses

Primary practice location

475 Cleveland Avenue N.
Suite 316
Saint Paul, MN 55104

Mailing address

475 Cleveland Avenue N.
Suite 316
Saint Paul, MN 55104
Phone (612) 524-9661

Other identifiers 2

IdentifierTypeStateIssuer
067948800MedicaidMN
411576550OtherMNPRACTICE LOCATION TAX ID

Other names 1

  • Alyssa Ann Clevenger Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240104003804 MN Practitioner - Marriage and Family Therapist 6305296229 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Larkey and Wright IncGroup PAC ID 2860842788, 10 clinicians

Practice addresses (Care Compare)

475 Cleveland Ave N
Suite 316
Saint Paul, MN 55104-5051
Phone (651) 330-3434

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Larkey and Wright Inc Marriage & Family Therapist CurrentSince Jan 1, 2016 Accepting new patients

Locations

475 Cleveland Ave N
Ste 316
Saint Paul, MN 55104
Phone (651) 330-3434

1973 Sloan Pl
Ste 225
Saint Paul, MN 55117
Phone (651) 330-3434

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680480000000",
    "number": "1174542567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 CLEVELAND AVENUE N.",
            "address_2": "SUITE 316",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "55104",
            "telephone_number": "612-524-9661",
            "fax_number": "651-330-3581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 CLEVELAND AVENUE N.",
            "address_2": "SUITE 316",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "55104",
            "telephone_number": "651-330-3434",
            "fax_number": "651-330-3581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "ALYSSA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "1539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067948800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRACTICE LOCATION TAX ID",
            "identifier": "411576550",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "CLEVENGER",
            "middle_name": "ANN",
            "credential": "LMFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.