Provider Demographics
NPI:1508333071
Name:MICKEY, ALYSA REY (LICSW)
Entity type:Individual
Prefix:
First Name:ALYSA
Middle Name:REY
Last Name:MICKEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 S COWLEY ST STE 9
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1263
Mailing Address - Country:US
Mailing Address - Phone:509-822-6777
Mailing Address - Fax:509-676-6655
Practice Address - Street 1:922 S COWLEY ST STE 9
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1263
Practice Address - Country:US
Practice Address - Phone:509-822-6777
Practice Address - Fax:509-676-6655
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60797144101Y00000X
390200000X
WALW615391801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program