Provider Demographics
NPI:1235434507
Name:ALLEN, STEPHANIE KIM (MSW, LICSW, GMHS)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:KIM
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW, LICSW, GMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4113
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608
Mailing Address - Country:US
Mailing Address - Phone:325-725-0162
Mailing Address - Fax:855-270-4606
Practice Address - Street 1:3301 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-7054
Practice Address - Country:US
Practice Address - Phone:325-725-0162
Practice Address - Fax:855-270-4606
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604173211041C0700X
TX1036851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2054960Medicaid
WAP01627692OtherRAILROAD MEDICARE