Provider Demographics
NPI:1720336217
Name:YOUNGBLOOD, ALICIA RENEE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:RENEE
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:RENEE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1326 HUNTER GREEN LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-7588
Mailing Address - Country:US
Mailing Address - Phone:281-824-4047
Mailing Address - Fax:
Practice Address - Street 1:1326 HUNTER GREEN LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-7588
Practice Address - Country:US
Practice Address - Phone:281-824-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX557061041C0700X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical