Provider Demographics
NPI:1770299380
Name:MCNABB, ADYSEN GARRETTE (LPC-A)
Entity type:Individual
Prefix:
First Name:ADYSEN
Middle Name:GARRETTE
Last Name:MCNABB
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4736 GAY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-1618
Mailing Address - Country:US
Mailing Address - Phone:530-521-5776
Mailing Address - Fax:
Practice Address - Street 1:1420 TWIN OAKS ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2723
Practice Address - Country:US
Practice Address - Phone:940-696-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty