Provider Demographics
NPI: | 1437738614 |
---|---|
Name: | ALLISON, JEFFREY (LLMSW) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | JEFFREY |
Middle Name: | |
Last Name: | ALLISON |
Suffix: | |
Gender: | M |
Credentials: | LLMSW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1885 MIDCHESTER DR |
Mailing Address - Street 2: | |
Mailing Address - City: | WEST BLOOMFIELD |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48324-1138 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-346-5491 |
Mailing Address - Fax: | 248-327-0333 |
Practice Address - Street 1: | 41000 WOODWARD AVE BLDG SUITE350 |
Practice Address - Street 2: | |
Practice Address - City: | BLOOMFIELD HILLS |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48304-5130 |
Practice Address - Country: | US |
Practice Address - Phone: | 248-796-2822 |
Practice Address - Fax: | 248-327-0333 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2021-04-06 |
Last Update Date: | 2021-04-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 6801109135 | 101YM0800X, 106H00000X, 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |