MEDICARE: DR. JOSEPH SCOTT ALLEN JR. PHD

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	103TC0700X	Clinical Psychologist	JA007894	MI

General Provider Information

NPI Number	:	1376524835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH SCOTT ALLEN JR. PHD

Provider Business Mailing Address
First Line	:	5419 TAMARACK PARK LN
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48346-3544
Country	:	US
Telephone Number	:	248-321-7890
Fax Number	:

Provider Business Practice Location Address
First Line	:	7736 ORTONVILLE RD STE A
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-4483
Country	:	US
Telephone Number	:	248-321-7890
Fax Number	:	248-321-7890

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	09/10/2018

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