Provider Demographics
NPI:1902332042
Name:RILEY, ALISON (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:E
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:IDAHO CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83631-0454
Mailing Address - Country:US
Mailing Address - Phone:512-337-6685
Mailing Address - Fax:
Practice Address - Street 1:7006 KILDARE CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-3654
Practice Address - Country:US
Practice Address - Phone:512-337-6855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX532071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372538403Medicaid
TX1821695610OtherGROUP NPI