Provider Demographics
NPI:1275147829
Name:ALLISON R BROYLES LLC
Entity Type:Organization
Organization Name:ALLISON R BROYLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:BROYLES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-899-6300
Mailing Address - Street 1:258 WHITFILL RD
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-0426
Mailing Address - Country:US
Mailing Address - Phone:817-899-6300
Mailing Address - Fax:
Practice Address - Street 1:301 S ROGERS ST STE 202
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3348
Practice Address - Country:US
Practice Address - Phone:817-899-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty