Provider Demographics
NPI:1578545216
Name:ALLEN, SHIRLEY SUMMER (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:SUMMER
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUMMER
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3950 E DEER PARK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-9716
Mailing Address - Country:US
Mailing Address - Phone:573-443-4168
Mailing Address - Fax:
Practice Address - Street 1:401 WEST BLVD N
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2665
Practice Address - Country:US
Practice Address - Phone:573-875-6662
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01541103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling