Provider Demographics
NPI:1710100490
Name:ALLEN, CHRISS N (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISS
Middle Name:N
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6260
Mailing Address - Country:US
Mailing Address - Phone:760-598-4528
Mailing Address - Fax:619-298-7267
Practice Address - Street 1:2125 S EL CAMINO REAL
Practice Address - Street 2:SUITE 206
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6260
Practice Address - Country:US
Practice Address - Phone:760-598-4528
Practice Address - Fax:619-298-7267
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 11664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY116640Medicaid
CACP11664Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST