Healthcare Provider Details

I. General information

NPI: 1356553853
Provider Name (Legal Business Name): ALLEN JOSEPH TAMAREN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RIO VISTA
ST. LOUIS MO
63124-1745
US

IV. Provider business mailing address

4 RUI VISTA
ST. LOUIS MO
63124-1745
US

V. Phone/Fax

Practice location:
  • Phone: 314-863-7228
  • Fax: 314-863-7228
Mailing address:
  • Phone: 314-863-7228
  • Fax: 314-863-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number01226
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: