Provider Demographics
NPI:1295918084
Name:VANDENHOUTEN, ALLISON (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:VANDENHOUTEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 TOWN CENTER CIR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3686
Mailing Address - Country:US
Mailing Address - Phone:954-349-1060
Mailing Address - Fax:
Practice Address - Street 1:1640 TOWN CENTER CIR
Practice Address - Street 2:SUITE 204
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3686
Practice Address - Country:US
Practice Address - Phone:954-349-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7112103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist