Alyssa Fernandez
Individual provider Active NPI Mental Health Counselor · Portland, TN
NPI 1457766537 · NPPES record last updated Jun 26, 2014
Key facts
- NPI
- 1457766537
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 105653115 (TN)
- Practice address
- 604 S Broadway St
Portland, TN 37148-1607 - Phone
- (615) 325-4146
- NPI assigned
- Jun 26, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105653115 | TN | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 105653115 | TN | Yes |
Addresses
Primary practice location
604 S Broadway St
Portland, TN 37148-1607
Mailing address
109 Hunterwood Dr
White House, TN 37188-8045
NPI Registry JSON
{
"created_epoch": "1403740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403740800000",
"number": "1457766537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 HUNTERWOOD DR",
"city": "WHITE HOUSE",
"state": "TN",
"postal_code": "371888045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "604 S BROADWAY ST",
"city": "PORTLAND",
"state": "TN",
"postal_code": "371481607",
"telephone_number": "615-325-4146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDEZ",
"first_name": "ALYSSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-26",
"last_updated": "2014-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TN",
"license": "105653115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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All providers in Portland, TN · Mental Health Counselor in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.