MEDICARE: ALISON RENEE PUGH 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
1	1041C0700X	Clinical Social Worker	LICSW1143199	MA
2	1041C0700X	Clinical Social Worker	ISW04292	RI
3	1041C0700X	Clinical Social Worker	60605	TX

General Provider Information

NPI Number	:	1407461866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON RENEE PUGH LCSW

Provider Business Mailing Address
First Line	:	1781 HIGHWAY 287 N # 1076
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-4807
Country	:	US
Telephone Number	:	254-266-6059
Fax Number	:

Provider Business Practice Location Address
First Line	:	1781 HIGHWAY 287 N # 1076
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-4807
Country	:	US
Telephone Number	:	254-266-6059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2020
Last Update Date	:	04/22/2026

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