Provider Demographics
NPI:1407408164
Name:ALLEN, JAIME LYN
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E MAGNOLIA BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2626
Mailing Address - Country:US
Mailing Address - Phone:754-245-7606
Mailing Address - Fax:
Practice Address - Street 1:4521 SHERMAN OAKS AVE STE 101
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3807
Practice Address - Country:US
Practice Address - Phone:818-849-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist