Provider Demographics
NPI:1164759676
Name:ALLEN, LAWRENCE JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JAY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:202 E MCDOWELL RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4588
Mailing Address - Country:US
Mailing Address - Phone:602-226-3693
Mailing Address - Fax:480-607-7128
Practice Address - Street 1:202 E MCDOWELL RD
Practice Address - Street 2:SUITE 132
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4588
Practice Address - Country:US
Practice Address - Phone:602-226-3693
Practice Address - Fax:480-607-7128
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0764103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist