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General NPI Number Information
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NPI Number | 1629593504
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Entity Type | Individual
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Provider Name | JUSTIN ALLEN MSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 8550 HUDSON BLVD N
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City | LAKE ELMO
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State | MN
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Zip | 55042-5500
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Country | US
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Telephone | 651-254-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 FRANCE AVE S STE 230
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City | EDINA
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State | MN
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Zip | 55435-1810
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23615
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License Number State | MN
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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 |
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License Number State |
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