Provider Demographics
NPI:1326191784
Name:ALLEN, MADALYNE MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MADALYNE
Middle Name:MARIE
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:PO BOX 9286
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-9286
Mailing Address - Country:US
Mailing Address - Phone:940-322-9200
Mailing Address - Fax:940-691-2458
Practice Address - Street 1:2301 KELL BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1007
Practice Address - Country:US
Practice Address - Phone:940-322-9200
Practice Address - Fax:940-691-2159
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX273067OtherTRICARE
TX5343LCOtherBLUE CROSS BLUE SHIELD
TX864867OtherCHIP PROGRAM