Provider Demographics
NPI:1578688370
Name:ALLEN, GARY TRENT (MA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:TRENT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:TRENT
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC, LMHC, CPC
Mailing Address - Street 1:183 VEGA ST
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-4914
Mailing Address - Country:US
Mailing Address - Phone:206-683-4541
Mailing Address - Fax:
Practice Address - Street 1:183 VEGA ST
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-4914
Practice Address - Country:US
Practice Address - Phone:206-683-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010784101Y00000X, 101YM0800X
NVCP5104-R101YM0800X
CALPCC11760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor