Provider Demographics
NPI:1659492601
Name:BABITZKE, ALISON (MS, LPE)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:BABITZKE
Suffix:
Gender:F
Credentials:MS, LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W B ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3506
Mailing Address - Country:US
Mailing Address - Phone:479-692-3702
Mailing Address - Fax:866-569-0146
Practice Address - Street 1:1110 W B ST
Practice Address - Street 2:SUITE H
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3506
Practice Address - Country:US
Practice Address - Phone:479-692-3702
Practice Address - Fax:866-569-0146
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR07-06E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health