Provider Demographics
NPI:1740602705
Name:ALLEN, DIANE CARBALLO (BCBA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:CARBALLO
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 S PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3492
Mailing Address - Country:US
Mailing Address - Phone:720-826-8779
Mailing Address - Fax:888-920-2198
Practice Address - Street 1:12201 S PARKER RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3492
Practice Address - Country:US
Practice Address - Phone:720-826-8779
Practice Address - Fax:888-920-2198
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-20-46416103K00000X
CO0-13-5729106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst