Provider Demographics
NPI:1831502046
Name:ALLEN, CHAD TIMOTHY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:TIMOTHY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 LASALLE AVE
Mailing Address - Street 2:APT 1804
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2361
Mailing Address - Country:US
Mailing Address - Phone:612-889-8185
Mailing Address - Fax:
Practice Address - Street 1:3137 HENNEPIN AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2601
Practice Address - Country:US
Practice Address - Phone:612-889-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional