MEDICARE: MICHAEL 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	BH001887	MD
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1821638271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ALLEN

Provider Business Mailing Address
First Line	:	2850 N RIDGE RD STE 210
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 N RIDGE RD STE 210
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3463
Country	:	US
Telephone Number	:	410-961-8423
Fax Number	:

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

Provider Enumeration Date	:	01/14/2020
Last Update Date	:	01/14/2020

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Directions to “ MICHAEL ALLEN ” Practice Location

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