Provider Demographics
NPI:1053875070
Name:RALSTIN, ALYSEN (MS)
Entity type:Individual
Prefix:
First Name:ALYSEN
Middle Name:
Last Name:RALSTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ALYSEN
Other - Middle Name:
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 SYCAMORE ST # 903
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2397
Mailing Address - Country:US
Mailing Address - Phone:929-459-8030
Mailing Address - Fax:
Practice Address - Street 1:1200 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2397
Practice Address - Country:US
Practice Address - Phone:972-825-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0016378101YM0800X
TX86675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty