Provider Demographics
NPI:1275842148
Name:ALLEN, ANN M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:301 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534-2508
Mailing Address - Country:US
Mailing Address - Phone:228-376-3473
Mailing Address - Fax:
Practice Address - Street 1:98 JEFF DAVIS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-6160
Practice Address - Country:US
Practice Address - Phone:228-236-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC57341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09233770Medicaid