Healthcare Provider Details

I. General information

NPI: 1023397270
Provider Name (Legal Business Name): KING ALLEN COUNTS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 11/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 TINY TOWN RD
CLARKSVILLE TN
37042-7663
US

IV. Provider business mailing address

915 TINY TOWN RD PO BOX 20626
CLARKSVILLE TN
37042-7663
US

V. Phone/Fax

Practice location:
  • Phone: 931-553-6981
  • Fax:
Mailing address:
  • Phone: 931-553-6981
  • Fax: 931-553-6982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0000000647
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: