Provider Demographics
NPI:1396203790
Name:ALLEN, PAULA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 CRUMPLER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1936
Mailing Address - Country:US
Mailing Address - Phone:901-826-9653
Mailing Address - Fax:
Practice Address - Street 1:6810 CRUMPLER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1936
Practice Address - Country:US
Practice Address - Phone:901-826-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2723101Y00000X, 101YM0800X
101YM0800X
MSP-0539101YM0800X
TX88314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSW9443OtherMS BOARD OF SOCIAL WORKERS
MS200000450Medicaid