Provider Demographics
NPI:1225456460
Name:ALLEN, GAYLE ANN (BAA,CPCT,BAT)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ANN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BAA,CPCT,BAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 WILDWOOD ST STE B
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-7166
Mailing Address - Country:US
Mailing Address - Phone:361-596-3651
Mailing Address - Fax:361-600-2093
Practice Address - Street 1:1802 WILDWOOD ST STE B
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-7166
Practice Address - Country:US
Practice Address - Phone:361-596-3651
Practice Address - Fax:361-600-2093
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3245S0500X, 171W00000X
TX25894411347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No347C00000XTransportation ServicesPrivate Vehicle