Provider Demographics
NPI:1407013089
Name:POURTEAU, ALISON E (LPC-S)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:E
Last Name:POURTEAU
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:E
Other - Last Name:COHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11004
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-1004
Mailing Address - Country:US
Mailing Address - Phone:979-217-1315
Mailing Address - Fax:
Practice Address - Street 1:3608 E 29TH ST
Practice Address - Street 2:STE 206
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3849
Practice Address - Country:US
Practice Address - Phone:979-217-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health