Provider Demographics
NPI:1114026945
Name:ALLSTUN, LEO WALTER JR (LPC, CEAP, SAP)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:WALTER
Last Name:ALLSTUN
Suffix:JR
Gender:M
Credentials:LPC, CEAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2907 INDEPENDENCE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5044
Mailing Address - Country:US
Mailing Address - Phone:573-334-7667
Mailing Address - Fax:573-335-1338
Practice Address - Street 1:2907 INDEPENDENCE ST
Practice Address - Street 2:SUITE G
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5044
Practice Address - Country:US
Practice Address - Phone:573-334-7667
Practice Address - Fax:573-335-1338
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional