Healthcare Provider Details

I. General information

NPI: 1801456702
Provider Name (Legal Business Name): ALLEN WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6922 22ND ST W
UNIVERSITY PLACE WA
98466-7600
US

IV. Provider business mailing address

6922 22ND ST W
UNIVERSITY PLACE WA
98466-7600
US

V. Phone/Fax

Practice location:
  • Phone: 253-213-2182
  • Fax: 253-369-9651
Mailing address:
  • Phone: 253-213-2182
  • Fax: 253-369-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA M ALLEN
Title or Position: OWNER
Credential: LICSW
Phone: 253-213-2182