MEDICARE: CAROLYN FAYE ALLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083040109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN FAYE ALLEN

Provider Business Mailing Address
First Line	:	1800 4TH ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-2726
Country	:	US
Telephone Number	:	727-824-5736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 4TH ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-2726
Country	:	US
Telephone Number	:	727-824-5736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	09/20/2013

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