Provider Demographics
NPI:1033749965
Name:NOVAK, ALLISON RITA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RITA
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 PINON CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-3930
Mailing Address - Country:US
Mailing Address - Phone:630-464-8971
Mailing Address - Fax:
Practice Address - Street 1:1225 KEN PRATT BLVD UNIT 206
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9017
Practice Address - Country:US
Practice Address - Phone:630-464-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011821101YM0800X
COLPC.0015580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health