Provider Demographics
NPI:1033401732
Name:BURWELL, ALLISON BLYTHE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:BLYTHE
Last Name:BURWELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4435
Mailing Address - Country:US
Mailing Address - Phone:512-796-0060
Mailing Address - Fax:
Practice Address - Street 1:1228 N HWY 123
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7730
Practice Address - Country:US
Practice Address - Phone:512-796-0060
Practice Address - Fax:512-796-0060
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67752101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9724LLOtherBCBS