MEDICARE: NICOLE ALLEN MS, LPC, RPT, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	73870	TX

General Provider Information

NPI Number	:	1194347278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ALLEN MS, LPC, RPT, NCC

Provider Business Mailing Address
First Line	:	231 W SYCAMORE ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-6057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 YUCCA DR STE 202
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2753
Country	:	US
Telephone Number	:	940-268-3717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	05/12/2020

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