Healthcare Provider Details

I. General information

NPI: 1013099589
Provider Name (Legal Business Name): CLAUDINE ALLEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5647 DELMAR BLVD
SAINT LOUIS MO
63112-2615
US

IV. Provider business mailing address

4433 LACLEDE AVE
SAINT LOUIS MO
63108-2203
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-1707
  • Fax:
Mailing address:
  • Phone: 314-531-8070
  • Fax: 314-209-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2000164960
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: