Healthcare Provider Details

I. General information

NPI: 1548846389
Provider Name (Legal Business Name): MISS TALEAH ASHLYN ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 BANDIT TRL
KELLER TX
76248-0111
US

IV. Provider business mailing address

1205 W GREEN OAKS BLVD STE B
ARLINGTON TX
76013-8333
US

V. Phone/Fax

Practice location:
  • Phone: 817-984-6855
  • Fax:
Mailing address:
  • Phone: 817-457-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-355036
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: