Provider Demographics
NPI:1700861002
Name:ALLAIN, JACKIE NELL (MA, LPCS)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:NELL
Last Name:ALLAIN
Suffix:
Gender:F
Credentials:MA, LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W AVENUE F
Mailing Address - Street 2:P.O. BOX 642
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2963
Mailing Address - Country:US
Mailing Address - Phone:972-723-0044
Mailing Address - Fax:972-775-2002
Practice Address - Street 1:408 W AVENUE F
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-2963
Practice Address - Country:US
Practice Address - Phone:972-723-0044
Practice Address - Fax:972-775-2002
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12988101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126066OtherNORTHSTAR