Healthcare Provider Details

I. General information

NPI: 1700371861
Provider Name (Legal Business Name): LINDA COOK ALLEN MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 8TH AVE # B3-6
GAINESVILLE FL
32601-5011
US

IV. Provider business mailing address

6026 NW 106TH PL
ALACHUA FL
32615-6769
US

V. Phone/Fax

Practice location:
  • Phone: 352-301-2248
  • Fax:
Mailing address:
  • Phone: 352-301-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: