Provider Demographics
NPI:1790977528
Name:C. CHRISTOPHER. ALLEN, PH.D., P.S.C.
Entity Type:Organization
Organization Name:C. CHRISTOPHER. ALLEN, PH.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-263-2367
Mailing Address - Street 1:111 DENNIS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2916
Mailing Address - Country:US
Mailing Address - Phone:859-276-5243
Mailing Address - Fax:859-260-1538
Practice Address - Street 1:111 DENNIS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2916
Practice Address - Country:US
Practice Address - Phone:859-276-5243
Practice Address - Fax:859-260-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0820103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9677Medicare PIN