Provider Demographics
NPI:1518069426
Name:ALLEN, EMILY ANNE (MS, LPC, LSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, LPC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5051
Mailing Address - Country:US
Mailing Address - Phone:208-465-5433
Mailing Address - Fax:208-466-5802
Practice Address - Street 1:112 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5051
Practice Address - Country:US
Practice Address - Phone:208-465-5433
Practice Address - Fax:208-466-5802
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3143101YM0800X
IDLSW-2568104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010153419OtherBLUESHIELD