Healthcare Provider Details

I. General information

NPI: 1578846713
Provider Name (Legal Business Name): JAMES ALLEN JR. LPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 W COMMERCIAL DR SUITE C
NORTH LITTLE ROCK AR
72116-7057
US

IV. Provider business mailing address

829 HALBERT ST
MALVERN AR
72104-2607
US

V. Phone/Fax

Practice location:
  • Phone: 501-753-8400
  • Fax: 501-753-8401
Mailing address:
  • Phone: 501-332-4400
  • Fax: 501-332-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10-17AE
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: