Provider Demographics
NPI:1417193392
Name:ERNST, ALLEN C
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:C
Last Name:ERNST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5619 LA POSTA RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-7986
Mailing Address - Country:US
Mailing Address - Phone:303-325-6895
Mailing Address - Fax:
Practice Address - Street 1:5619 LA POSTA RD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-7986
Practice Address - Country:US
Practice Address - Phone:303-325-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health