MEDICARE: ALLISON EVANS COUNSELING AND CONSULTING, PLLC

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	:	1457951972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLISON EVANS COUNSELING AND CONSULTING, PLLC

Provider Business Mailing Address
First Line	:	1584 SEMINOLE DR
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-1450
Country	:	US
Telephone Number	:	501-658-3156
Fax Number	:

Provider Business Practice Location Address
First Line	:	1584 SEMINOLE DR
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-1450
Country	:	US
Telephone Number	:	501-658-3156
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	SAMANTHA J ALLISON
Credential	:	LPC
Telephone Number	:	501-658-3156

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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