Healthcare Provider Details

I. General information

NPI: 1063203354
Provider Name (Legal Business Name): ALLISON LEIGH SHUB LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W 51ST ST UNIT 1
AUSTIN TX
78756-2659
US

IV. Provider business mailing address

1415 W 51ST ST UNIT 1
AUSTIN TX
78756-2659
US

V. Phone/Fax

Practice location:
  • Phone: 512-201-4501
  • Fax:
Mailing address:
  • Phone: 512-201-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113913
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: