Provider Demographics
NPI:1174640544
Name:ALLEN, JIMMIE DEAN (EDD)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:DEAN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 FREDEREICK AVE
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-387-2615
Mailing Address - Fax:816-387-2390
Practice Address - Street 1:3505 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2914
Practice Address - Country:US
Practice Address - Phone:816-387-2615
Practice Address - Fax:816-387-2390
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001006337103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist