Provider Demographics
NPI:1265696751
Name:ALLRED, BRIAN LAMAR (LPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LAMAR
Last Name:ALLRED
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 MAGEE ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-3182
Mailing Address - Country:US
Mailing Address - Phone:573-384-5755
Mailing Address - Fax:573-384-5756
Practice Address - Street 1:308 BUCK CREEK RD
Practice Address - Street 2:
Practice Address - City:SILEX
Practice Address - State:MO
Practice Address - Zip Code:63377-2116
Practice Address - Country:US
Practice Address - Phone:573-384-5755
Practice Address - Fax:573-384-5756
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO26-0605001322D00000X
UT111470-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children