Provider Demographics
NPI:1679355200
Name:ALLEN, ANTOINE II (PLPC)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:
Last Name:ALLEN
Suffix:II
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 JULIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63133-2011
Mailing Address - Country:US
Mailing Address - Phone:314-374-5524
Mailing Address - Fax:
Practice Address - Street 1:3751 PENNRIDGE DR STE 119
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-1244
Practice Address - Country:US
Practice Address - Phone:314-239-2728
Practice Address - Fax:949-561-4148
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional