Healthcare Provider Details

I. General information

NPI: 1750552808
Provider Name (Legal Business Name): ALISSA SHERRY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W 10TH ST
AUSTIN TX
78701-2033
US

IV. Provider business mailing address

707 W 10TH ST
AUSTIN TX
78701-2033
US

V. Phone/Fax

Practice location:
  • Phone: 512-791-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32248
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number32248
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number32248
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number32248
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number32248
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: