Individual
MRS. ALYSSA LEA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2200 S LAKELINE BLVD, CEDAR PARK, TX 78613-4567
(512) 219-0200
Mailing address
2200 S LAKELINE BLVD, CEDAR PARK, TX 78613-4567
(512) 219-0200
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
209841
TX
Other
Enumeration date
12/14/2015
Last updated
12/14/2015
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