Healthcare Provider Details

I. General information

NPI: 1720684152
Provider Name (Legal Business Name): MR. MICHAEL JOSEPH ALLEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date: 01/05/2021
Reactivation Date: 01/27/2021

III. Provider practice location address

7200 BANCROFT AVE STE 133
OAKLAND CA
94605-2480
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 133
OAKLAND CA
94605-2480
US

V. Phone/Fax

Practice location:
  • Phone: 510-254-5157
  • Fax: 510-338-4889
Mailing address:
  • Phone: 510-254-5157
  • Fax: 510-338-4889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: