Provider Demographics
NPI:1326272576
Name:HESSE, ALLEN V (BCABA)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:V
Last Name:HESSE
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 FOUNTAINHEAD DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4228
Mailing Address - Country:US
Mailing Address - Phone:727-586-5785
Mailing Address - Fax:727-585-4214
Practice Address - Street 1:1158 FOUNTAINHEAD DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4228
Practice Address - Country:US
Practice Address - Phone:727-586-5785
Practice Address - Fax:727-585-4214
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-03
Last Update Date:2009-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
FL0-04-1288103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)