Provider Demographics
NPI:1598950040
Name:ALLEN, DOUGLAS GREGORY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GREGORY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:9600 ESCARPMENT BLVD
Mailing Address - Street 2:SUITE #745-188
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1982
Mailing Address - Country:US
Mailing Address - Phone:512-466-9457
Mailing Address - Fax:512-590-8727
Practice Address - Street 1:3006 BEE CAVES RD
Practice Address - Street 2:SUITE D-208
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5588
Practice Address - Country:US
Practice Address - Phone:512-466-9457
Practice Address - Fax:512-590-8727
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33416103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist