Provider Demographics
NPI:1649757824
Name:ALLEN, STANLEY LEROY
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:LEROY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 SHE NAH NUM DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-9105
Mailing Address - Country:US
Mailing Address - Phone:360-413-2727
Mailing Address - Fax:360-455-4620
Practice Address - Street 1:4820 SHE NAH NUM DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513
Practice Address - Country:US
Practice Address - Phone:360-413-2727
Practice Address - Fax:360-455-4620
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)