Provider Demographics
NPI:1306388749
Name:ALLEN, SARA DIANE (PHD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DIANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S JUPITER RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7708
Mailing Address - Country:US
Mailing Address - Phone:972-272-4429
Mailing Address - Fax:972-494-2812
Practice Address - Street 1:1025 S JUPITER RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7708
Practice Address - Country:US
Practice Address - Phone:972-272-4429
Practice Address - Fax:972-494-2812
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical