Provider Demographics
NPI:1790123719
Name:ALLEN, DEREK LEON (LPC)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:LEON
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 S POWER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3740
Mailing Address - Country:US
Mailing Address - Phone:602-633-5032
Mailing Address - Fax:602-633-5032
Practice Address - Street 1:1234 S POWER RD STE 100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3740
Practice Address - Country:US
Practice Address - Phone:602-633-5032
Practice Address - Fax:602-633-5032
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional