Healthcare Provider Details

I. General information

NPI: 1255196689
Provider Name (Legal Business Name): JIMMY ALCALA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E RUNDBERG LN STE E
AUSTIN TX
78753-4813
US

IV. Provider business mailing address

211 E 7TH ST STE 700
AUSTIN TX
78701-3218
US

V. Phone/Fax

Practice location:
  • Phone: 866-278-8432
  • Fax: 737-707-3910
Mailing address:
  • Phone: 866-278-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number62474
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number62474
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: