MEDICARE: ALISA ZACHERY 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	67168	TX
2	1041C0700X	Clinical Social Worker	12366	LA
3	1041C0700X	Clinical Social Worker	96047	CA

General Provider Information

NPI Number	:	1811328172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA ZACHERY LCSW

Provider Business Mailing Address
First Line	:	10800 GOSLING RD UNIT 130142
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77393-4008
Country	:	US
Telephone Number	:	510-686-3446
Fax Number	:	832-202-1360

Provider Business Practice Location Address
First Line	:	10800 GOSLING RD UNIT 130142
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77393-4008
Country	:	US
Telephone Number	:	510-686-3446
Fax Number	:	832-202-1360

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

Provider Enumeration Date	:	12/11/2013
Last Update Date	:	10/06/2021

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