=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124341425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEN OUTREACH INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2010
-----------------------------------------------------
Last Update Date | 12/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 N 13TH ST
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71463-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-335-3578
-----------------------------------------------------
Fax | 318-335-3753
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 N 13TH ST
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71463-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-335-3578
-----------------------------------------------------
Fax | 318-335-3753
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SUPERVISOR
-----------------------------------------------------
Name | DR. SCOTT LEJEUNE
-----------------------------------------------------
Credential | LPC-S, LMFT
-----------------------------------------------------
Telephone | 318-335-3578
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 220
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------