Provider Demographics
NPI:1114961646
Name:ALLEN, MICHAEL ROY (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-3702
Mailing Address - Country:US
Mailing Address - Phone:337-267-7866
Mailing Address - Fax:337-267-7876
Practice Address - Street 1:611 W ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6408
Practice Address - Country:US
Practice Address - Phone:337-373-0002
Practice Address - Fax:337-373-0129
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical