Provider Demographics
NPI:1841400470
Name:ALLEN, WILLIAM D I (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:ALLEN
Suffix:I
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4672 STAVERN PT
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2639
Mailing Address - Country:US
Mailing Address - Phone:612-701-3813
Mailing Address - Fax:
Practice Address - Street 1:621 WEST LAKE STREET
Practice Address - Street 2:SUITE 330
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2925
Practice Address - Country:US
Practice Address - Phone:612-701-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist