Provider Demographics
NPI:1427571603
Name:ALLEN, PHILLIP M
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
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 1:2417 ROUND TOP DR APT B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2061
Mailing Address - Country:US
Mailing Address - Phone:808-208-2015
Mailing Address - Fax:
Practice Address - Street 1:2 AARONA PL STE 208
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2545
Practice Address - Country:US
Practice Address - Phone:808-263-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst