Individual
MS. ALYSA MICHELE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
3000 'J' STREET,, FEDERAL MEDICAL CENTER, CARSWELL, FORT WORTH, TX 76127
(817) 782-4002
Mailing address
5425 DEER ISLAND DR, FORT WORTH, TX 76179-1481
(254) 833-0663
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
075695
NY
Other
Enumeration date
05/03/2006
Last updated
10/10/2016
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