Individual
ALYSSA SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 SANDIA PLZ, BRYAN, TX 77802-4356
(979) 217-1378
Mailing address
1401 SANDIA PLZ, BRYAN, TX 77802-4356
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
86421
TX
Other
Enumeration date
02/21/2022
Last updated
02/21/2022
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