Provider Demographics
NPI:1427258664
Name:ALISON KUNEFKE MASHBURN, LPC, PA
Entity type:Organization
Organization Name:ALISON KUNEFKE MASHBURN, LPC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-791-1051
Mailing Address - Street 1:5221 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2664
Mailing Address - Country:US
Mailing Address - Phone:903-791-1051
Mailing Address - Fax:903-791-1054
Practice Address - Street 1:5221 N PARK RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2664
Practice Address - Country:US
Practice Address - Phone:903-791-1051
Practice Address - Fax:903-791-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60958101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty