Provider Demographics
NPI:1073063558
Name:ALLEN, KRISTEN (MS, LMHC, MCAP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, LMHC, MCAP
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMHC, MCAP
Mailing Address - Street 1:15301 WALL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2349
Mailing Address - Country:US
Mailing Address - Phone:239-200-5258
Mailing Address - Fax:
Practice Address - Street 1:15301 WALL DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2349
Practice Address - Country:US
Practice Address - Phone:239-200-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH18326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty