Provider Demographics
NPI:1609812049
Name:ALLEN, THOMAS W (EDD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:ALLEN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 MILBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4611
Mailing Address - Country:US
Mailing Address - Phone:314-935-6732
Mailing Address - Fax:
Practice Address - Street 1:14323 S OUTER 40
Practice Address - Street 2:SUITE 607
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5739
Practice Address - Country:US
Practice Address - Phone:314-935-6732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00351103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical