Healthcare Provider Details

I. General information

NPI: 1003300187
Provider Name (Legal Business Name): JARYN LYNN ALLEN PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 AMBER VALLEY PKWY S STE W
FARGO ND
58104-8647
US

IV. Provider business mailing address

4733 AMBER VALLEY PKWY S STE W
FARGO ND
58104-8647
US

V. Phone/Fax

Practice location:
  • Phone: 701-368-7400
  • Fax:
Mailing address:
  • Phone: 701-368-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number528
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: