Provider Demographics
NPI:1770847477
Name:ALLEN, KEISHA (LCSW)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:RALLIFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 559 BOX 6862
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96377-0069
Mailing Address - Country:US
Mailing Address - Phone:954-732-4480
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDICAL GROUP, UNIT 5142
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5142
Practice Address - Country:US
Practice Address - Phone:954-732-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55184104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker