Provider Demographics
NPI:1417454638
Name:ALLEN, JASON (CSW, MFT ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:CSW, MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ANTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3440
Mailing Address - Country:US
Mailing Address - Phone:502-345-1977
Mailing Address - Fax:
Practice Address - Street 1:101 NOAHS LN
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-282-8479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252730104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker