Healthcare Provider Details

I. General information

NPI: 1659852648
Provider Name (Legal Business Name): JEFFERY K ALLEN JR. MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 10/26/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BROADWAY STE 1200
OAKLAND CA
94612-1814
US

IV. Provider business mailing address

1465 165TH AVE APT 111
SAN LEANDRO CA
94578-3141
US

V. Phone/Fax

Practice location:
  • Phone: 855-427-2778
  • Fax: 510-834-2045
Mailing address:
  • Phone: 706-817-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: