Provider Demographics
NPI:1033623194
Name:ALLEN, LUKE ROY (PHD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:ROY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E FLAMINGO ROAD
Mailing Address - Street 2:S107 1456
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-1435
Mailing Address - Country:US
Mailing Address - Phone:702-530-6134
Mailing Address - Fax:725-269-1561
Practice Address - Street 1:4950 S RAINBOW BLVD #150 #3008
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1435
Practice Address - Country:US
Practice Address - Phone:702-530-6134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY1030103TC1900X, 103T00000X
OR3473103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling