Provider Demographics
NPI:1437308061
Name:ALLEN, CLEMENTINE (MHPP)
Entity Type:Individual
Prefix:MRS
First Name:CLEMENTINE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:CLEMENTINE
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHPP
Mailing Address - Street 1:7 CLOVER CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-7102
Mailing Address - Country:US
Mailing Address - Phone:501-753-5400
Mailing Address - Fax:501-753-8404
Practice Address - Street 1:7 CLOVER CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-7102
Practice Address - Country:US
Practice Address - Phone:501-753-5400
Practice Address - Fax:501-753-8404
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator