Provider Demographics
NPI:1598546418
Name:ALLEN, JEANIIA
Entity Type:Individual
Prefix:
First Name:JEANIIA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 COUNTY ROAD 15 LOT 200
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9664
Mailing Address - Country:US
Mailing Address - Phone:260-302-1329
Mailing Address - Fax:
Practice Address - Street 1:1201 COUNTY ROAD 15 LOT 200
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9664
Practice Address - Country:US
Practice Address - Phone:260-302-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health