MEDICARE: MRS. ALLISON M CORNELL 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	101YP2500X	Professional Counselor	71371	TX

General Provider Information

NPI Number	:	1659878601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON M CORNELL LPC-S

Provider Business Mailing Address
First Line	:	1505 ELIKA CT
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3263
Country	:	US
Telephone Number	:	254-749-0483
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 FIREWHEEL DR
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2628
Country	:	US
Telephone Number	:	254-749-0483
Fax Number	:

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

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	11/29/2023

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