Provider Demographics
NPI:1922439918
Name:ALLEN, KEITH (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
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 1:9164 DEL RIO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8016
Mailing Address - Country:US
Mailing Address - Phone:810-232-9950
Mailing Address - Fax:810-232-7599
Practice Address - Street 1:9164 DEL RIO DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8016
Practice Address - Country:US
Practice Address - Phone:810-232-9950
Practice Address - Fax:810-232-7599
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional