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General NPI Number Information
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NPI Number | 1437415965
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Entity Type | Organization
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Legal Business Name | J SCOTT ALLEN JR PHD LLC
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 26111 W 14 MILE RD # 201C
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City | FRANKLIN
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State | MI
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Zip | 48025-1168
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Country | US
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Telephone | 248-626-7008
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Fax | 248-626-7057
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Provider Business Mailing Address
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Address Line | 26111 W 14 MILE RD # 201C
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City | FRANKLIN
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State | MI
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Zip | 48025-1168
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Country | US
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Telephone | 248-626-7008
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Fax | 248-626-7057
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Authorized Official
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Title or Position | PHD
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Name | DR. J SCOTT ALLEN JR.
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Credential | PHD
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Telephone | 248-626-7008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | JA007894
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License Number State | MI
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