Provider Demographics
NPI:1568512127
Name:ALLEN, CHARLES PERRY (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:PERRY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 MISSION OAKS BLVD
Mailing Address - Street 2:SUITE 45
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5400
Mailing Address - Country:US
Mailing Address - Phone:805-657-2425
Mailing Address - Fax:805-389-0447
Practice Address - Street 1:1601 CARMEN DR
Practice Address - Street 2:SUITE 211
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3105
Practice Address - Country:US
Practice Address - Phone:805-657-2425
Practice Address - Fax:805-389-0447
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical