MEDICARE: MR. JONATHAN DREW 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		OK

General Provider Information

NPI Number	:	1750959037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN DREW ALLEN

Provider Business Mailing Address
First Line	:	12005 SW 51ST ST
Second Line	:
City	:	MUSTANG
State	:	OK
Zip	:	73064-7909
Country	:	US
Telephone Number	:	918-734-7851
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 S WESTERN AVE STE 215
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-4525
Country	:	US
Telephone Number	:	405-605-8488
Fax Number	:

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	04/17/2026

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