Active NPI
Alicia McCullough Jarry, LCSW
- Mental Health Counselor
- Austin, TX
National Provider Identifier
1861540494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 26415
- Practice address
- 603 W 18TH St
Austin, TX 78701-1166 - Phone
- (512) 482-8828
- Fax
- (512) 482-8828
- NPI assigned
- Jan 8, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 26415 | TX | Primary |
Addresses
Primary practice location
603 W 18TH St
Austin, TX 78701-1166
Mailing address
2828 Pearl St
Austin, TX 78705-3535
Phone (512) 482-8828
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0044GJ | Other | TX | BLUECROSSBLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26415 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861540494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2828 PEARL ST",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787053535",
"telephone_number": "512-482-8828",
"fax_number": "512-482-8828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 W 18TH ST",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787011166",
"telephone_number": "512-482-8828",
"fax_number": "512-482-8828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARRY",
"first_name": "ALICIA",
"middle_name": "MCCULLOUGH",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "26415",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD",
"identifier": "0044GJ",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.