Healthcare Provider Details

I. General information

NPI: 1508609157
Provider Name (Legal Business Name): KIMBERLY ALLEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5713 SUPERIOR DR STE B3
BATON ROUGE LA
70816-8015
US

IV. Provider business mailing address

12805 RUBY LAKE DR
WALKER LA
70785-3436
US

V. Phone/Fax

Practice location:
  • Phone: 225-364-7551
  • Fax:
Mailing address:
  • Phone: 225-337-6847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY ALLEN
Title or Position: OWNER
Credential: LCSW
Phone: 225-337-6847