Healthcare Provider Details

I. General information

NPI: 1891129185
Provider Name (Legal Business Name): KLETA A ALLEN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1876 S SHERIDAN AVE
SHERIDAN WY
82801-6136
US

IV. Provider business mailing address

1221 W 5TH ST
SHERIDAN WY
82801-2701
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-0475
  • Fax:
Mailing address:
  • Phone: 307-672-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1533
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-1533
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: