Provider Demographics
NPI:1326751876
Name:ALLEN, BRANDON JARRETT (TCM)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JARRETT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PAR LN STE 101
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9059
Mailing Address - Country:US
Mailing Address - Phone:270-312-2500
Mailing Address - Fax:
Practice Address - Street 1:100 PAR LN STE 101
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9059
Practice Address - Country:US
Practice Address - Phone:270-312-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management