Healthcare Provider Details

I. General information

NPI: 1669991576
Provider Name (Legal Business Name): KIMBERLY B ALLEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 AVENUE F
ELY NV
89301-3500
US

IV. Provider business mailing address

PO BOX 151107
ELY NV
89315-1107
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-1671
  • Fax: 775-289-1699
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI0848
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4149
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: