Individual
EBON SCOTT ALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
6900 ALDEN DR, 90 MDG, FE WARREN AFB, WY 82005-3906
(307) 773-2998
(307) 773-4721
Mailing address
7924 SIRINGO PASS, AUSTIN, TX 78749-2727
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
11902
MA
Other
Enumeration date
09/20/2005
Last updated
03/09/2012
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