Provider Demographics
NPI:1831468354
Name:ALFORD, JANELLE (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:
Last Name:ALFORD
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 BROWN TRL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7042
Mailing Address - Country:US
Mailing Address - Phone:817-716-0455
Mailing Address - Fax:866-777-1027
Practice Address - Street 1:2106 W PIONEER PKWY
Practice Address - Street 2:SUITE 128
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-6093
Practice Address - Country:US
Practice Address - Phone:817-716-0455
Practice Address - Fax:866-777-1027
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX298216701Medicaid