MEDICARE: CARRIE M ALLEN PHD, LPC-S

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	101YM0800X	Mental Health Counselor	71834	TX
2	103TC1900X	Counseling Psychologist	71834	TX
3	101YP2500X	Professional Counselor	71834	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497110415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE M ALLEN PHD, LPC-S

Provider Business Mailing Address
First Line	:	PO BOX 163781
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-3781
Country	:	US
Telephone Number	:	682-651-7621
Fax Number	:	817-887-3409

Provider Business Practice Location Address
First Line	:	1285 N MAIN ST STE 101-5
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1511
Country	:	US
Telephone Number	:	682-651-7621
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	10/17/2024

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