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General NPI Number Information
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NPI Number | 1285163709
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Entity Type | Individual
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Provider Name | SHERRITA M ALLEN
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 104 CRESCENT DR
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City | LEBANON
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State | MO
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Zip | 65536-3301
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Country | US
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Telephone | 417-588-5885
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Fax | 417-588-4296
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Provider Business Mailing Address
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Address Line | 15405 COUSTEAU DR
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City | FLORISSANT
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State | MO
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Zip | 63034-2254
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Country | US
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Telephone | 417-300-3386
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2017010257
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License Number State | MO
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