Healthcare Provider Details

I. General information

NPI: 1851110357
Provider Name (Legal Business Name): ALLISON WORTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 N HIGHWAY 59 STE G-K
MERCED CA
95348-9404
US

IV. Provider business mailing address

1249 ILLINOIS AVE
LOS BANOS CA
93635-3906
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-2125
  • Fax:
Mailing address:
  • Phone: 209-587-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: