Provider Demographics
NPI:1053867895
Name:ALLEN, SHIRLEY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:ALLEN
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 1:5604 WESLEY ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6326
Mailing Address - Country:US
Mailing Address - Phone:903-274-4140
Mailing Address - Fax:
Practice Address - Street 1:5604 WESLEY ST STE 103
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6326
Practice Address - Country:US
Practice Address - Phone:903-274-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health