Provider Demographics
NPI:1497920714
Name:ALLEN, ANGELA ADELE (NCC, LMHC, BCBA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ADELE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NCC, LMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 REDWING DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1909
Mailing Address - Country:US
Mailing Address - Phone:812-373-6103
Mailing Address - Fax:
Practice Address - Street 1:1069 REDWING DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-1909
Practice Address - Country:US
Practice Address - Phone:812-373-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002189A101YM0800X
101Y00000X
IN1-16-23617103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty