Provider Demographics
NPI:1659049799
Name:ENTZI, ALYSSA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:M
Last Name:ENTZI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 RED QUILL NEST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5518
Mailing Address - Country:US
Mailing Address - Phone:210-385-5757
Mailing Address - Fax:
Practice Address - Street 1:319 RED QUILL NEST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5518
Practice Address - Country:US
Practice Address - Phone:210-385-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX609101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical