Provider Demographics
NPI:1376524835
Name:ALLEN, JOSEPH SCOTT JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SCOTT
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:SCOTT
Other - Last Name:ALLEN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5419 TAMARACK PARK LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3544
Mailing Address - Country:US
Mailing Address - Phone:248-321-7890
Mailing Address - Fax:
Practice Address - Street 1:7736 ORTONVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4483
Practice Address - Country:US
Practice Address - Phone:248-321-7890
Practice Address - Fax:248-321-7890
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJA007894103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M54850Medicare ID - Type Unspecified
MIR66196Medicare UPIN