Healthcare Provider Details

I. General information

NPI: 1558816314
Provider Name (Legal Business Name): ALLISON WHITE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 S IH 35
AUSTIN TX
78744-2713
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-804-3650
  • Fax: 512-476-0217
Mailing address:
  • Phone: 512-472-4357
  • Fax: 512-703-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number61911
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: