MEDICARE: ALLEN'S COUNSELING AND CONSULTATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639717937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN'S COUNSELING AND CONSULTATION

Provider Business Mailing Address
First Line	:	5631 S LA CIENEGA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1333
Country	:	US
Telephone Number	:	310-613-1962
Fax Number	:

Provider Business Practice Location Address
First Line	:	5631 S LA CIENEGA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1333
Country	:	US
Telephone Number	:	310-613-1962
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	CLYMIE ALLEN
Credential	:	LCSW
Telephone Number	:	310-613-1962

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	01/13/2020

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