Provider Demographics
NPI:1275544900
Name:ALLISON, JUDY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:ANN
Last Name:ALLISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S KOENIGHEIM ST
Mailing Address - Street 2:STE 3E
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6769
Mailing Address - Country:US
Mailing Address - Phone:325-659-3700
Mailing Address - Fax:325-659-3722
Practice Address - Street 1:502 S KOENIGHEIM ST
Practice Address - Street 2:STE 3E
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6769
Practice Address - Country:US
Practice Address - Phone:325-659-3700
Practice Address - Fax:325-659-3722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12372101YP2500X
TX14992103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0081LKOtherBLUE CROSS BLUE SHIELD
TX611082Medicare ID - Type UnspecifiedMEDICARE