Provider Demographics
NPI:1255888137
Name:KATHLEENLALLENMALPCLLC
Entity type:Organization
Organization Name:KATHLEENLALLENMALPCLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-903-2419
Mailing Address - Street 1:145 EVANS CT
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-8638
Mailing Address - Country:US
Mailing Address - Phone:970-903-2419
Mailing Address - Fax:970-731-3107
Practice Address - Street 1:145 EVANS CT
Practice Address - Street 2:475 LEWIS ST. ST.212
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8638
Practice Address - Country:US
Practice Address - Phone:970-903-2419
Practice Address - Fax:970-731-3107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATHLEENLALLEN MALPCLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00001731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty