Provider Demographics
NPI:1558837096
Name:ALSTON, ALLEN MATTHEW
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:MATTHEW
Last Name:ALSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 N. 4TH ST M&S CLINICAL SVC.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206
Mailing Address - Country:US
Mailing Address - Phone:414-263-6000
Mailing Address - Fax:414-263-2270
Practice Address - Street 1:2821 N. 4TH ST M&S CLINICAL SVC.
Practice Address - Street 2:SUITE 210
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206
Practice Address - Country:US
Practice Address - Phone:414-263-6000
Practice Address - Fax:414-263-2270
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2258-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional