Provider Demographics
NPI:1902605017
Name:ALLEN, CARLY JILL (PPC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:JILL
Last Name:ALLEN
Suffix:
Gender:
Credentials:PPC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:JILL
Other - Last Name:YORK BANKS RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:1109 DAYLILY LOOP
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7153
Mailing Address - Country:US
Mailing Address - Phone:307-274-6881
Mailing Address - Fax:
Practice Address - Street 1:1109 DAYLILY LOOP
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7153
Practice Address - Country:US
Practice Address - Phone:307-274-6881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health