Provider Demographics
NPI:1457079477
Name:ALLEN, MARGOT ANNE (MFTC)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6243 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5814
Mailing Address - Country:US
Mailing Address - Phone:970-310-0774
Mailing Address - Fax:
Practice Address - Street 1:1011 37TH AVENUE CT STE AND202
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2562
Practice Address - Country:US
Practice Address - Phone:970-825-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMFTC.0014353OtherPROVISIONAL LICENSE