MEDICARE: ALPHA NEURO LLC

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

General Provider Information

NPI Number	:	1609646835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA NEURO LLC

Provider Business Mailing Address
First Line	:	2918 BEACON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-9208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2918 BEACON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-9208
Country	:	US
Telephone Number	:	214-701-0158
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JESSICA K ALLEN
Credential	:	PH.D., LP, BCBA
Telephone Number	:	214-701-0158

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	05/13/2024

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Directions to “ALPHA NEURO LLC ” Practice Location

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