Provider Demographics
NPI:1396865242
Name:ALLEN, KRISTIN BROOKE (MS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BROOKE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 TRILLIUM CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1717
Mailing Address - Country:US
Mailing Address - Phone:859-312-4195
Mailing Address - Fax:
Practice Address - Street 1:3526 TRILLIUM CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1717
Practice Address - Country:US
Practice Address - Phone:859-312-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0589103TC0700X
FLMH19191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical