Provider Demographics
NPI:1538464474
Name:ALLISON, MARY (MA, LPC/MHSP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:ALLISON
Suffix:
Gender:F
Credentials:MA, LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 RICHMOND HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-6611
Mailing Address - Country:US
Mailing Address - Phone:423-383-4149
Mailing Address - Fax:423-573-1716
Practice Address - Street 1:204 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1704
Practice Address - Country:US
Practice Address - Phone:423-383-4149
Practice Address - Fax:423-573-1716
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional