Provider Demographics
NPI:1487061818
Name:ALLISON, NICK (LPC)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:ALLISON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W 4TH S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2319
Mailing Address - Country:US
Mailing Address - Phone:208-534-8607
Mailing Address - Fax:
Practice Address - Street 1:343 E 4TH N STE 231
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-6009
Practice Address - Country:US
Practice Address - Phone:208-656-4017
Practice Address - Fax:208-656-4018
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5525101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional