Healthcare Provider Details

I. General information

NPI: 1881143006
Provider Name (Legal Business Name): ALYSSA WILLIAMS MABC, LPC INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E ANDERSON LN BUILDING 3, SUITE 100
AUSTIN TX
78752-1236
US

IV. Provider business mailing address

11106 WHISKEY RIVER DR
AUSTIN TX
78748-1870
US

V. Phone/Fax

Practice location:
  • Phone: 512-961-5575
  • Fax:
Mailing address:
  • Phone: 512-431-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number71698
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: