Healthcare Provider Details

I. General information

NPI: 1326736125
Provider Name (Legal Business Name): BRITTANY LEE ALLEN BA, MA, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 PACIFIC AVE
NORTH BEND OR
97459-2605
US

IV. Provider business mailing address

281 LACLAIR ST
COOS BAY OR
97420-2988
US

V. Phone/Fax

Practice location:
  • Phone: 541-808-4715
  • Fax:
Mailing address:
  • Phone: 541-808-4715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: