Provider Demographics
NPI:1942374863
Name:ALLIN, JOHN MAURY JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MAURY
Last Name:ALLIN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N STATE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1689
Mailing Address - Country:US
Mailing Address - Phone:601-714-4477
Mailing Address - Fax:601-714-4433
Practice Address - Street 1:1600 N STATE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1689
Practice Address - Country:US
Practice Address - Phone:601-714-4477
Practice Address - Fax:601-714-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical