MEDICARE: EMILY ALLEN

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	101YM0800X	Mental Health Counselor	95553	TX

General Provider Information

NPI Number	:	1245028653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ALLEN

Provider Business Mailing Address
First Line	:	11620 SCOTT SIMPSON DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6258
Country	:	US
Telephone Number	:	941-457-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 WOODROW BEAN STE 129
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-4144
Country	:	US
Telephone Number	:	915-355-5874
Fax Number	:

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

Provider Enumeration Date	:	04/26/2025
Last Update Date	:	04/26/2025

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