Individual provider Active NPI

Alysha N Roll, LCSW

  • Clinical Social Worker
  • Kingwood, TX
National Provider Identifier
1962473934
Registry record updated Feb 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
39144 Issued in TX
Practice address
2330 Timber Shadows Dr
Ste 106
Kingwood, TX 77339-2042
Phone
(832) 623-2102
NPI assigned
Jan 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 39144 TX Primary

Addresses

Primary practice location

2330 Timber Shadows Dr
Ste 106
Kingwood, TX 77339-2042

Mailing address

2330 Timber Shadows Dr
Ste 106
Kingwood, TX 77339-2042
Phone (832) 623-2102

Other identifiers 2

IdentifierTypeStateIssuer
612320OtherTXMEDICARE
178883801MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060328000371 TX Practitioner - Clinical Social Worker 5698783959 Practice locations: Kingwood, TX

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1525 Lakeville Dr
Suite 108
Kingwood, TX 77339-2068
Phone (832) 623-2102

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kinghaven Counseling Group Inc Clinical Past Accepting new patients
Journey to a New Path, PLLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487808000000",
    "number": "1962473934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 TIMBER SHADOWS DR",
            "address_2": "STE 106",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773392042",
            "telephone_number": "832-623-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 TIMBER SHADOWS DR",
            "address_2": "STE 106",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773392042",
            "telephone_number": "832-623-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLL",
        "first_name": "ALYSHA",
        "middle_name": "N",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2017-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "39144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "612320",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178883801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingwood, TX

Sources for this page

Verify at the official NPI Registry.