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General NPI Number Information
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NPI Number | 1063302404
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Entity Type | Individual
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Provider Name | ALYSSA MARIE RAELYNN LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 5455 LA SIERRA DR
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City | DALLAS
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State | TX
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Zip | 75231-4178
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Country | US
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Telephone | 214-691-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 7929 CHURCHILL WAY APT 1122
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City | DALLAS
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State | TX
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Zip | 75251-2080
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Country | US
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Telephone | 469-947-4885
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Fax | 469-947-4885
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 105447
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License Number State | TX
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