Provider Demographics
NPI:1174542567
Name:WRIGHT, ALYSSA ANN (LMFT)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:ANN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ANN
Other - Last Name:CLEVENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:475 CLEVELAND AVENUE N.
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:612-524-9661
Mailing Address - Fax:651-330-3581
Practice Address - Street 1:475 CLEVELAND AVENUE N.
Practice Address - Street 2:SUITE 316
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-330-3434
Practice Address - Fax:651-330-3581
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1539106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN067948800Medicaid
MN411576550OtherPRACTICE LOCATION TAX ID