Healthcare Provider Details

I. General information

NPI: 1346750924
Provider Name (Legal Business Name): ALLEN COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13375 UNIVERSITY AVE STE 201
CLIVE IA
50325-8260
US

IV. Provider business mailing address

13375 UNIVERSITY AVE STE 201
CLIVE IA
50325-8260
US

V. Phone/Fax

Practice location:
  • Phone: 515-207-0310
  • Fax:
Mailing address:
  • Phone: 515-207-0310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number001420
License Number StateIA

VIII. Authorized Official

Name: ANGELA LEIGH ALLEN
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 515-207-0310