Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 70250 | TX |
N | 101YM0800X | Mental Health Counselor | 70250 | TX |
N | 101YP2500X | Professional Counselor | 70250 | TX |
NPI | 1003479239 |
---|---|
Provider Name | Mr. Ty A Allison |
First Address | Dallas, TX 75243-6412 |
Second Address | Dallas, TX 75219-4369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2019 |
Last Update Date | 14/04/2019 |