Provider Demographics
NPI:1548719719
Name:EAGLE, ALLIE ROSE (LMFT, LCDC)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:ROSE
Last Name:EAGLE
Suffix:
Gender:F
Credentials:LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7470 GOLDEN POND PL STE 300
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-2100
Mailing Address - Country:US
Mailing Address - Phone:806-356-9047
Mailing Address - Fax:806-356-9046
Practice Address - Street 1:7470 GOLDEN POND PL STE 300
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-2100
Practice Address - Country:US
Practice Address - Phone:325-650-3433
Practice Address - Fax:806-356-9046
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist