Provider Demographics
NPI:1497110415
Name:ALLEN, CARRIE M (PHD, LPC-S)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 N MAIN ST STE 101-5
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1511
Mailing Address - Country:US
Mailing Address - Phone:682-651-7621
Mailing Address - Fax:
Practice Address - Street 1:1285 N MAIN ST STE 101-5
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1511
Practice Address - Country:US
Practice Address - Phone:682-651-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355748001Medicaid