Provider Demographics
NPI:1184753311
Name:ALLEN, RONALD LYNN (PHD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LYNN
Last Name:ALLEN
Suffix:
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 1:9217 PARK WEST BLVD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4404
Mailing Address - Country:US
Mailing Address - Phone:865-691-2425
Mailing Address - Fax:865-531-8440
Practice Address - Street 1:9217 PARK WEST BLVD
Practice Address - Street 2:SUITE D-1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4404
Practice Address - Country:US
Practice Address - Phone:865-691-2425
Practice Address - Fax:865-531-8440
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1392103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2005918OtherBLUE CROSS BLUE SHIELD
TN3680005Medicaid
TNP1392OtherPSYCHOLOGIST LICENSE
TNP1392OtherPSYCHOLOGIST LICENSE