MEDICARE: RANICSHA 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	171M00000X	Case Manager/Care Coordinator
2	101Y00000X	Counselor	PLC10097	LA
3	101YP2500X	Professional Counselor	PLC10097	LA
4	101YM0800X	Mental Health Counselor	PLC10097	LA

General Provider Information

NPI Number	:	1285005348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANICSHA ALLEN

Provider Business Mailing Address
First Line	:	137 OAK HAVEN DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70507-4525
Country	:	US
Telephone Number	:	337-501-1106
Fax Number	:

Provider Business Practice Location Address
First Line	:	2448 JOHNSTON ST
Second Line	:	STE B
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-2756
Country	:	US
Telephone Number	:	337-233-7250
Fax Number	:	337-233-7104

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

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	05/28/2026

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Directions to “ RANICSHA ALLEN ” Practice Location

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