MEDICARE: ALICIA RYALS AYERS LCSW, LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	16124	TX
2	1041C0700X	Clinical Social Worker	69424	TX

General Provider Information

NPI Number	:	1316661424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA RYALS AYERS LCSW, LCDC

Provider Business Mailing Address
First Line	:	3120 SOUTHWEST FWY STE 101
Second Line	:	PMB 244832
City	:	HOUSTON
State	:	TX
Zip	:	77098-4520
Country	:	US
Telephone Number	:	713-489-7238
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 SOUTHWEST FWY STE 101
Second Line	:	PMB 244832
City	:	HOUSTON
State	:	TX
Zip	:	77098-4520
Country	:	US
Telephone Number	:	713-489-7238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	08/03/2024

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