Provider Demographics
NPI:1407275985
Name:MIDDLETON, ALAN (PHD, LPC-S, RPT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:PHD, LPC-S, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E BAR LE DOC DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6247
Mailing Address - Country:US
Mailing Address - Phone:361-728-2113
Mailing Address - Fax:
Practice Address - Street 1:5337 YORKTOWN BLVD STE 302
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5376
Practice Address - Country:US
Practice Address - Phone:361-334-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12152101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional