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General NPI Number Information
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NPI Number | 1134459548
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Entity Type | Individual
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Provider Name | STACEY LYN ALLEN CSW
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Gender | Female
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1675 CURLEW DR
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City | AMMON
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State | ID
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Zip | 83406-4718
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Country | US
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Telephone | 208-523-5319
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2106
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City | IDAHO FALLS
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State | ID
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Zip | 83403-2106
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Country | US
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Telephone | 208-360-2850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LMSW-30182
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMSW-30182
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-30182
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW-30182
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 35279
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License Number State | ID
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