Provider Demographics
NPI:1235363938
Name:ALLEN, MARILYN MOANA (LMHC LMFT CAP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:MOANA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMHC LMFT CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6157 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-1823
Mailing Address - Country:US
Mailing Address - Phone:352-438-4040
Mailing Address - Fax:
Practice Address - Street 1:6157 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34479-1823
Practice Address - Country:US
Practice Address - Phone:352-438-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4262101YM0800X
FLMT1944106H00000X
FLADC-003433-2014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7621981 00Medicaid