MEDICARE: DORA ALLISON

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1073798633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORA ALLISON

Provider Business Mailing Address
First Line	:	11635 FM 349
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75603-7505
Country	:	US
Telephone Number	:	903-240-7430
Fax Number	:	903-236-8521

Provider Business Practice Location Address
First Line	:	11635 FM 349
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75603-7505
Country	:	US
Telephone Number	:	903-240-7430
Fax Number	:	903-236-8521

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	DORA ALLISON
Credential	:
Telephone Number	:	903-240-7430

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	01/02/2008

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Directions to “DORA ALLISON ” Practice Location

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