Provider Demographics
NPI:1417221144
Name:ALLEN, NICHOLAS R
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:R
Last Name:ALLEN
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 1:15 DECLARATION DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4902
Mailing Address - Country:US
Mailing Address - Phone:530-893-4784
Mailing Address - Fax:
Practice Address - Street 1:15 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4902
Practice Address - Country:US
Practice Address - Phone:530-893-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health