Provider Demographics
NPI:1154630192
Name:ALLEN, JOHN T
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4895 E RUSSELL RD
Mailing Address - Street 2:#308
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4503
Mailing Address - Country:US
Mailing Address - Phone:702-580-2344
Mailing Address - Fax:
Practice Address - Street 1:4895 E RUSSELL RD
Practice Address - Street 2:#308
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4503
Practice Address - Country:US
Practice Address - Phone:702-580-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst