Healthcare Provider Details

I. General information

NPI: 1144609934
Provider Name (Legal Business Name): ALICIA RENEE SCHOEPHOERSTER DBH, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA RENEE WYCOFF

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 E BROADWAY BLVD STE 101
TUCSON AZ
85710-2835
US

IV. Provider business mailing address

6355 S DESERT PEAK DR
TUCSON AZ
85706-0116
US

V. Phone/Fax

Practice location:
  • Phone: 623-499-3218
  • Fax:
Mailing address:
  • Phone: 520-334-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23569
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: