Provider Demographics
NPI:1316522600
Name:AGAN, ALLISON MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:AGAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-0841
Mailing Address - Country:US
Mailing Address - Phone:903-563-1364
Mailing Address - Fax:
Practice Address - Street 1:2003 LOGANS POINTE DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-4141
Practice Address - Country:US
Practice Address - Phone:903-563-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103936104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker