Provider Demographics
NPI:1275004194
Name:ALLEN, MISTY RENE (LPC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:RENE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 OLD PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-5449
Mailing Address - Country:US
Mailing Address - Phone:936-433-4929
Mailing Address - Fax:
Practice Address - Street 1:340 PAN AMERICAN DR STE B3
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-4065
Practice Address - Country:US
Practice Address - Phone:936-433-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health