Provider Demographics
NPI:1922569169
Name:CLEVINGER, ALLISON KAY (MA)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:KAY
Last Name:CLEVINGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8606 E WHITEWATER DR APT 116
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1268
Mailing Address - Country:US
Mailing Address - Phone:714-585-1209
Mailing Address - Fax:
Practice Address - Street 1:1101 CALIFORNIA AVE STE 212
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6472
Practice Address - Country:US
Practice Address - Phone:951-523-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-45226103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-20-45226OtherBEHAVIOR ANALYST CERTIFICATION BOARD