Healthcare Provider Details

I. General information

NPI: 1720336217
Provider Name (Legal Business Name): ALICIA RENEE YOUNGBLOOD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA RENEE HILL LMSW

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 HUNTER GREEN LN
FRESNO TX
77545-7588
US

IV. Provider business mailing address

1326 HUNTER GREEN LN
FRESNO TX
77545-7588
US

V. Phone/Fax

Practice location:
  • Phone: 281-824-4047
  • Fax:
Mailing address:
  • Phone: 281-824-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number55706
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number55706
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: