Healthcare Provider Details

I. General information

NPI: 1427258664
Provider Name (Legal Business Name): ALISON KUNEFKE MASHBURN, LPC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 N PARK RD
TEXARKANA TX
75503-2664
US

IV. Provider business mailing address

5221 N PARK RD
TEXARKANA TX
75503-2664
US

V. Phone/Fax

Practice location:
  • Phone: 903-791-1051
  • Fax: 903-791-1054
Mailing address:
  • Phone: 903-791-1051
  • Fax: 903-791-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number60958
License Number StateTX

VIII. Authorized Official

Name: ALISON MASHBURN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 903-791-1051