Provider Demographics
NPI:1003985409
Name:ALLEN, MICKI (LPC)
Entity Type:Individual
Prefix:
First Name:MICKI
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:11059 E BETHANY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2622
Mailing Address - Country:US
Mailing Address - Phone:303-617-2300
Mailing Address - Fax:303-617-2397
Practice Address - Street 1:10782 E ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1017
Practice Address - Country:US
Practice Address - Phone:303-617-2626
Practice Address - Fax:303-617-2672
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional