Provider Demographics
NPI:1275101677
Name:ALLEN, JONATHAN KEITH (LMSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:KEITH
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 TOWNER ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5723
Mailing Address - Country:US
Mailing Address - Phone:734-544-3000
Mailing Address - Fax:734-544-6716
Practice Address - Street 1:750 TOWNER ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5724
Practice Address - Country:US
Practice Address - Phone:734-544-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011182631041C0700X
MI68511101581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical