Provider Demographics
NPI:1215025325
Name:ALLEN, BARBARA (MA)
Entity Type:Individual
Prefix:MISS
First Name:BARBARA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1211
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90742-1211
Mailing Address - Country:US
Mailing Address - Phone:562-533-8902
Mailing Address - Fax:
Practice Address - Street 1:1151 DOVE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2840
Practice Address - Country:US
Practice Address - Phone:714-520-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical