Provider Demographics
NPI:1558510644
Name:ALLEN, ROBERT LYN (MA,MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LYN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MA,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 BANBURY PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4609
Mailing Address - Country:US
Mailing Address - Phone:323-257-0543
Mailing Address - Fax:323-257-0050
Practice Address - Street 1:2662 BANBURY PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-4609
Practice Address - Country:US
Practice Address - Phone:323-257-0543
Practice Address - Fax:323-257-0050
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT13693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist