Provider Demographics
NPI:1295500643
Name:LYSSY, ASHLEY NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:LYSSY
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 1:17206 BLANCO RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2816
Mailing Address - Country:US
Mailing Address - Phone:210-209-0642
Mailing Address - Fax:855-357-8282
Practice Address - Street 1:17206 BLANCO RD BLDG 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2816
Practice Address - Country:US
Practice Address - Phone:210-209-0642
Practice Address - Fax:855-357-8282
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX668001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical