Provider Demographics
NPI:1255124335
Name:SPENCER, ALISSA
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FARMALL LN
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-7101
Mailing Address - Country:US
Mailing Address - Phone:541-941-4005
Mailing Address - Fax:
Practice Address - Street 1:2417 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3811
Practice Address - Country:US
Practice Address - Phone:406-600-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional