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NPI Code Detail

MEDICARE: MARISOL ALAS LCSW

MEDICARE: MARISOL ALAS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker103970TX

General Provider Information

NPI Number : 1205262623
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISOL ALAS LCSW
Provider Business Mailing Address
First Line : PO BOX 2138
Second Line :
City : BURLESON
State : TX
Zip : 76097-2138
Country : US
Telephone Number : 909-331-7897
Fax Number :
Provider Business Practice Location Address
First Line : 1000 SAINT LOUIS AVE STE 101
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3377
Country : US
Telephone Number : 817-810-0379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2013
Last Update Date : 01/03/2022

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Directions to “ MARISOL ALAS LCSW” Practice Location

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