Provider Demographics
NPI:1033463617
Name:ALLEN, MICHELLE (MASTER SOCIAL WORK)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MASTER SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15095 AMARGOSA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1875
Mailing Address - Country:US
Mailing Address - Phone:760-217-3267
Mailing Address - Fax:
Practice Address - Street 1:15095 AMARGOSA RD STE 205
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1879
Practice Address - Country:US
Practice Address - Phone:760-217-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-03
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CAASW82298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical