Provider Demographics
NPI:1710342969
Name:ALLEN, DECINDA (IMF)
Entity Type:Individual
Prefix:
First Name:DECINDA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 W HENDERSON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1490
Mailing Address - Country:US
Mailing Address - Phone:559-788-1200
Mailing Address - Fax:559-713-3757
Practice Address - Street 1:1055 W HENDERSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1490
Practice Address - Country:US
Practice Address - Phone:559-788-1200
Practice Address - Fax:559-713-3757
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT101318106H00000X
CA101318106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist