Provider Demographics
NPI:1366509606
Name:AULT, ALLISON M (LMHC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:AULT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2201
Mailing Address - Country:US
Mailing Address - Phone:716-218-1400
Mailing Address - Fax:716-332-2820
Practice Address - Street 1:2875 UNION RD STE 48
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1466
Practice Address - Country:US
Practice Address - Phone:716-681-7394
Practice Address - Fax:716-648-7101
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY00000341101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030241501OtherUNIVERA