Healthcare Provider Details

I. General information

NPI: 1215065412
Provider Name (Legal Business Name): ALISA L HARTFIELD LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 SAINT JULIEN CT
SAN ANTONIO TX
78240-3538
US

IV. Provider business mailing address

9010 SAINT JULIEN CT
SAN ANTONIO TX
78240-3538
US

V. Phone/Fax

Practice location:
  • Phone: 210-682-6530
  • Fax: 210-682-3530
Mailing address:
  • Phone: 210-682-6530
  • Fax: 210-682-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number40197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: