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General NPI Number Information
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NPI Number | 1174809065
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Entity Type | Organization
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Legal Business Name | ALLEN COUNSELING AGENCY LLC
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 6106 KENSINGTON CT
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City | IMPERIAL
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State | MO
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Zip | 63052-2392
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Country | US
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Telephone | 314-602-9207
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Fax | 636-223-0905
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Provider Business Mailing Address
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Address Line | 6106 KENSINGTON CT
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City | IMPERIAL
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State | MO
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Zip | 63052-2392
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Country | US
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Telephone | 314-602-9207
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Fax | 636-223-0905
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELLI ALLEN
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Credential | MED, LPC
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Telephone | 314-602-9207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LC1177742
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License Number State | MO
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