Provider Demographics
NPI:1437796851
Name:ALLEN TEMPLE HEALTH & SOCIAL SERVICES MINISTRY
Entity Type:Organization
Organization Name:ALLEN TEMPLE HEALTH & SOCIAL SERVICES MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-544-8947
Mailing Address - Street 1:8501 INTERNATIONAL BLVD., C-105
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-1549
Mailing Address - Country:US
Mailing Address - Phone:510-544-8947
Mailing Address - Fax:510-544-8918
Practice Address - Street 1:8501 INTERNATIONAL BLVD., C-105
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1549
Practice Address - Country:US
Practice Address - Phone:510-544-8947
Practice Address - Fax:510-544-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty