Healthcare Provider Details

I. General information

NPI: 1336003714
Provider Name (Legal Business Name): KEVIN M ALLEN QMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 E 14TH AVE
COLUMBUS OH
43219-2304
US

IV. Provider business mailing address

2912 E 14TH AVE
COLUMBUS OH
43219-2304
US

V. Phone/Fax

Practice location:
  • Phone: 614-323-2628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: