Healthcare Provider Details

I. General information

NPI: 1619311495
Provider Name (Legal Business Name): ALLISON PUCKETT LMHC, CH.T., MATS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 STATE ST STE 244
NEW ALBANY IN
47150-6804
US

IV. Provider business mailing address

4990 E ROBIN RD
PEKIN IN
47165-7060
US

V. Phone/Fax

Practice location:
  • Phone: 812-670-5491
  • Fax: 812-670-5491
Mailing address:
  • Phone: 812-967-5192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001966A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: